This page is part of the FHIR Specification (v4.2.0: R5 Preview #1). 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
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)
EOB for an Claim that had errors
@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/ExplanationOfBenefit/EB3501> a fhir:ExplanationOfBenefit; fhir:nodeRole fhir:treeRoot; fhir:Resource.id [ fhir:value "EB3501"]; 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 ExplanationOfBenefit for a claim that had errors, various other attributes (such as accident and hospitalization) are also completed.</div>" ]; fhir:ExplanationOfBenefit.identifier [ fhir:index 0; fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/explanationofbenefit" ]; fhir:Identifier.value [ fhir:value "error-1" ] ]; fhir:ExplanationOfBenefit.status [ fhir:value "active"]; fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.subType [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-claimsubtype" ]; fhir:Coding.code [ fhir:value "emergency" ] ] ]; fhir:ExplanationOfBenefit.use [ fhir:value "claim"]; fhir:ExplanationOfBenefit.patient [ fhir:link <http://hl7.org/fhir/Patient/pat1>; fhir:Reference.reference [ fhir:value "Patient/pat1" ] ]; fhir:ExplanationOfBenefit.billablePeriod [ fhir:Period.start [ fhir:value "2014-02-01"^^xsd:date ]; fhir:Period.end [ fhir:value "2014-03-01"^^xsd:date ] ]; fhir:ExplanationOfBenefit.created [ fhir:value "2014-08-16"^^xsd:date]; fhir:ExplanationOfBenefit.enterer [ fhir:link <http://hl7.org/fhir/Practitioner/1>; fhir:Reference.reference [ fhir:value "Practitioner/1" ] ]; fhir:ExplanationOfBenefit.insurer [ fhir:link <http://hl7.org/fhir/Organization/2>; fhir:Reference.reference [ fhir:value "Organization/2" ] ]; fhir:ExplanationOfBenefit.provider [ fhir:link <http://hl7.org/fhir/Organization/2>; fhir:Reference.reference [ fhir:value "Organization/2" ] ]; fhir:ExplanationOfBenefit.related [ fhir:index 0; fhir:ExplanationOfBenefit.related.reference [ fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/case-number" ]; fhir:Identifier.value [ fhir:value "23-56Tu-XX-47-20150M14" ] ] ]; fhir:ExplanationOfBenefit.prescription [ fhir:link <http://hl7.org/fhir/MedicationRequest/medrx002>; fhir:Reference.reference [ fhir:value "MedicationRequest/medrx002" ] ]; fhir:ExplanationOfBenefit.originalPrescription [ fhir:link <http://hl7.org/fhir/MedicationRequest/medrx0301>; fhir:Reference.reference [ fhir:value "MedicationRequest/medrx0301" ] ]; fhir:ExplanationOfBenefit.facility [ fhir:link <http://hl7.org/fhir/Location/1>; fhir:Reference.reference [ fhir:value "Location/1" ] ]; fhir:ExplanationOfBenefit.claim [ fhir:link <http://hl7.org/fhir/Claim/100150>; fhir:Reference.reference [ fhir:value "Claim/100150" ] ]; fhir:ExplanationOfBenefit.claimResponse [ fhir:link <http://hl7.org/fhir/ClaimResponse/R3500>; fhir:Reference.reference [ fhir:value "ClaimResponse/R3500" ] ]; fhir:ExplanationOfBenefit.outcome [ fhir:value "error"]; fhir:ExplanationOfBenefit.disposition [ fhir:value "Could not process."]; fhir:ExplanationOfBenefit.supportingInfo [ fhir:index 0; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ]; fhir:Coding.code [ fhir:value "employmentimpacted" ] ] ]; fhir:ExplanationOfBenefit.supportingInfo.timingPeriod [ fhir:Period.start [ fhir:value "2014-02-14"^^xsd:date ]; fhir:Period.end [ fhir:value "2014-02-28"^^xsd:date ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ]; fhir:Coding.code [ fhir:value "hospitalized" ] ] ]; fhir:ExplanationOfBenefit.supportingInfo.timingPeriod [ fhir:Period.start [ fhir:value "2014-02-14"^^xsd:date ]; fhir:Period.end [ fhir:value "2014-02-16"^^xsd:date ] ] ]; fhir:ExplanationOfBenefit.procedure [ fhir:index 0; fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2014-02-14"^^xsd:date ]; fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ]; fhir:Coding.code [ fhir:value "123001" ] ] ]; fhir:ExplanationOfBenefit.procedure.udi [ fhir:index 0; fhir:link <http://hl7.org/fhir/Device/example>; fhir:Reference.reference [ fhir:value "Device/example" ] ] ]; fhir:ExplanationOfBenefit.precedence [ fhir:value "2"^^xsd:positiveInteger]; fhir:ExplanationOfBenefit.insurance [ fhir:index 0; fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ]; fhir:ExplanationOfBenefit.insurance.coverage [ fhir:link <http://hl7.org/fhir/Coverage/9876B1>; fhir:Reference.reference [ fhir:value "Coverage/9876B1" ] ] ]; fhir:ExplanationOfBenefit.accident [ fhir:ExplanationOfBenefit.accident.date [ fhir:value "2014-02-14"^^xsd:date ]; fhir:ExplanationOfBenefit.accident.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ]; fhir:Coding.code [ fhir:value "SPT" ] ] ]; fhir:ExplanationOfBenefit.accident.locationReference [ fhir:link <http://hl7.org/fhir/Location/ph>; fhir:Reference.reference [ fhir:value "Location/ph" ] ] ]; fhir:ExplanationOfBenefit.total [ fhir:index 0; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "submitted" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "2478.57"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "0.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ] ]; fhir:ExplanationOfBenefit.formCode [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/forms-codes" ]; fhir:Coding.code [ fhir:value "2" ] ] ]; fhir:ExplanationOfBenefit.processNote [ fhir:index 0; fhir:ExplanationOfBenefit.processNote.number [ fhir:value "1"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.processNote.type [ fhir:value "display" ]; fhir:ExplanationOfBenefit.processNote.text [ fhir:value "Invalid claim" ]; fhir:ExplanationOfBenefit.processNote.language [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "urn:ietf:bcp:47" ]; fhir:Coding.code [ fhir:value "en-CA" ] ] ] ] . <http://hl7.org/fhir/Patient/pat1> a fhir:Patient . <http://hl7.org/fhir/Practitioner/1> a fhir:Practitioner . <http://hl7.org/fhir/Organization/2> a fhir:Organization . <http://hl7.org/fhir/MedicationRequest/medrx002> a fhir:MedicationRequest . <http://hl7.org/fhir/MedicationRequest/medrx0301> a fhir:MedicationRequest . <http://hl7.org/fhir/Location/1> a fhir:Location . <http://hl7.org/fhir/Claim/100150> a fhir:Claim . <http://hl7.org/fhir/ClaimResponse/R3500> a fhir:ClaimResponse . <http://hl7.org/fhir/Device/example> a fhir:Device . <http://hl7.org/fhir/Coverage/9876B1> a fhir:Coverage . <http://hl7.org/fhir/Location/ph> a fhir:Location . # - ontology header ------------------------------------------------------------ <http://hl7.org/fhir/ExplanationOfBenefit/EB3501.ttl> a owl:Ontology; owl:imports fhir:fhir.ttl; owl:versionIRI <http://build.fhir.org/ExplanationOfBenefit/EB3501.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.