Release 5 Ballot
This page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). 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 | Standards Status: Informative | Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson |
Raw Turtle (+ also see Turtle/RDF Format Specification)
Glasses Claim, 3 Tier, Secondary Coverage
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 -------------------------------------------------------------------
[a fhir:Claim;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "660152"];
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 Vision Claim for Glasses</div>"
];
fhir:DomainResource.contained [
a fhir:Device;
fhir:index 0;
fhir:Resource.id [ fhir:value "device-frame" ]
], [
a fhir:Device;
fhir:index 1;
fhir:Resource.id [ fhir:value "device-lens" ]
];
fhir:Claim.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://happysight.com/claim" ];
fhir:Identifier.value [ fhir:value "6612347" ]
];
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 "vision" ]
]
];
fhir:Claim.use [ fhir:value "claim"];
fhir:Claim.patient [
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:Claim.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:Claim.insurer [
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:Claim.provider [
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:Claim.priority [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "normal" ]
]
];
fhir:Claim.prescription [
fhir:link <http://www.optdocs.com/prescription/12345>;
fhir:Reference.reference [ fhir:value "http://www.optdocs.com/prescription/12345" ]
];
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: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.code [ fhir:value "654321" ]
]
]
];
fhir:Claim.insurance [
fhir:index 0;
fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.insurance.focal [ fhir:value "false"^^xsd:boolean ];
fhir:Claim.insurance.coverage [
fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]
];
fhir:Claim.insurance.preAuthRef [
fhir:value "PR7652387237";
fhir:index 0
];
fhir:Claim.insurance.claimResponse [
fhir:Reference.reference [ fhir:value "ClaimResponse/R3500" ]
]
], [
fhir:index 1;
fhir:Claim.insurance.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:Claim.insurance.coverage [
fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]
];
fhir:Claim.insurance.preAuthRef [
fhir:value "AB543GTD7567";
fhir:index 0
]
];
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.revenue [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ];
fhir:Coding.code [ fhir:value "0010" ];
fhir:Coding.display [ fhir:value "Vision Clinic" ]
]
];
fhir:Claim.item.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
fhir:Coding.code [ fhir:value "glasses" ]
]
];
fhir:Claim.item.modifier [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/modifiers" ];
fhir:Coding.code [ fhir:value "rooh" ]
]
];
fhir:Claim.item.programCode [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-programcode" ];
fhir:Coding.code [ fhir:value "none" ]
]
];
fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
fhir:Claim.item.unitPrice [
fhir:Money.value [ fhir:value "235.40"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.net [
fhir:Money.value [ fhir:value "235.40"^^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.revenue [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ];
fhir:Coding.code [ fhir:value "0010" ];
fhir:Coding.display [ fhir:value "Vision Clinic" ]
]
];
fhir:Claim.item.detail.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:Claim.item.detail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
fhir:Coding.code [ fhir:value "frame" ]
]
];
fhir:Claim.item.detail.modifier [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/modifiers" ];
fhir:Coding.code [ fhir:value "rooh" ]
]
];
fhir:Claim.item.detail.unitPrice [
fhir:Money.value [ fhir:value "100.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.factor [ fhir:value "1.1"^^xsd:decimal ];
fhir:Claim.item.detail.net [
fhir:Money.value [ fhir:value "110.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.udi [
fhir:index 0;
fhir:Reference.reference [ fhir:value "#device-frame" ]
]
], [
fhir:index 1;
fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.item.detail.revenue [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ];
fhir:Coding.code [ fhir:value "0010" ];
fhir:Coding.display [ fhir:value "Vision Clinic" ]
]
];
fhir:Claim.item.detail.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:Claim.item.detail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
fhir:Coding.code [ fhir:value "lens" ]
]
];
fhir:Claim.item.detail.programCode [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-programcode" ];
fhir:Coding.code [ fhir:value "none" ]
]
];
fhir:Claim.item.detail.quantity [
fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ]
];
fhir:Claim.item.detail.unitPrice [
fhir:Money.value [ fhir:value "55.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.net [
fhir:Money.value [ fhir:value "110.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.subDetail [
fhir:index 0;
fhir:Claim.item.detail.subDetail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.item.detail.subDetail.revenue [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ];
fhir:Coding.code [ fhir:value "0010" ];
fhir:Coding.display [ fhir:value "Vision Clinic" ]
]
];
fhir:Claim.item.detail.subDetail.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:Claim.item.detail.subDetail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
fhir:Coding.code [ fhir:value "lens" ]
]
];
fhir:Claim.item.detail.subDetail.modifier [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/modifiers" ];
fhir:Coding.code [ fhir:value "rooh" ]
]
];
fhir:Claim.item.detail.subDetail.programCode [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-programcode" ];
fhir:Coding.code [ fhir:value "none" ]
]
];
fhir:Claim.item.detail.subDetail.quantity [
fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ]
];
fhir:Claim.item.detail.subDetail.unitPrice [
fhir:Money.value [ fhir:value "30.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.subDetail.factor [ fhir:value "1.1"^^xsd:decimal ];
fhir:Claim.item.detail.subDetail.net [
fhir:Money.value [ fhir:value "66.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.subDetail.udi [
fhir:index 0;
fhir:Reference.reference [ fhir:value "#device-lens" ]
]
], [
fhir:index 1;
fhir:Claim.item.detail.subDetail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.item.detail.subDetail.revenue [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ];
fhir:Coding.code [ fhir:value "0010" ];
fhir:Coding.display [ fhir:value "Vision Clinic" ]
]
];
fhir:Claim.item.detail.subDetail.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:Claim.item.detail.subDetail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
fhir:Coding.code [ fhir:value "hardening" ]
]
];
fhir:Claim.item.detail.subDetail.modifier [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/modifiers" ];
fhir:Coding.code [ fhir:value "rooh" ]
]
];
fhir:Claim.item.detail.subDetail.quantity [
fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ]
];
fhir:Claim.item.detail.subDetail.unitPrice [
fhir:Money.value [ fhir:value "15.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.subDetail.factor [ fhir:value "1.1"^^xsd:decimal ];
fhir:Claim.item.detail.subDetail.net [
fhir:Money.value [ fhir:value "33.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 2;
fhir:Claim.item.detail.subDetail.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:Claim.item.detail.subDetail.revenue [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ];
fhir:Coding.code [ fhir:value "0010" ];
fhir:Coding.display [ fhir:value "Vision Clinic" ]
]
];
fhir:Claim.item.detail.subDetail.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:Claim.item.detail.subDetail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
fhir:Coding.code [ fhir:value "UV coating" ]
]
];
fhir:Claim.item.detail.subDetail.modifier [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/modifiers" ];
fhir:Coding.code [ fhir:value "rooh" ]
]
];
fhir:Claim.item.detail.subDetail.quantity [
fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ]
];
fhir:Claim.item.detail.subDetail.unitPrice [
fhir:Money.value [ fhir:value "5.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.subDetail.factor [ fhir:value "1.1"^^xsd:decimal ];
fhir:Claim.item.detail.subDetail.net [
fhir:Money.value [ fhir:value "11.00"^^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.revenue [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ];
fhir:Coding.code [ fhir:value "0010" ];
fhir:Coding.display [ fhir:value "Vision Clinic" ]
]
];
fhir:Claim.item.detail.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:Claim.item.detail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
fhir:Coding.code [ fhir:value "fst" ]
]
];
fhir:Claim.item.detail.unitPrice [
fhir:Money.value [ fhir:value "220.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.factor [ fhir:value "0.07"^^xsd:decimal ];
fhir:Claim.item.detail.net [
fhir:Money.value [ fhir:value "15.40"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
]
]] .
# - ontology header ------------------------------------------------------------
[a owl:Ontology;
owl:imports fhir:fhir.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.
FHIR ®© HL7.org 2011+. FHIR R5 Ballot hl7.fhir.core#5.0.0-ballot generated on Wed, Sep 7, 2022 11:07+1000.
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