Release 5 Ballot
FinancialThis 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)
General Person Primary Coverage EOB Example
@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:ExplanationOfBenefit;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "EB3500"];
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</div>"
];
fhir:ExplanationOfBenefit.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/explanationofbenefit" ];
fhir:Identifier.value [ fhir:value "987654321" ]
];
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.use [ fhir:value "claim"];
fhir:ExplanationOfBenefit.patient [
fhir:Reference.reference [ fhir:value "Patient/pat1" ]
];
fhir:ExplanationOfBenefit.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:ExplanationOfBenefit.enterer [
fhir:Reference.reference [ fhir:value "Practitioner/1" ]
];
fhir:ExplanationOfBenefit.insurer [
fhir:Reference.reference [ fhir:value "Organization/3" ]
];
fhir:ExplanationOfBenefit.provider [
fhir:Reference.reference [ fhir:value "Practitioner/1" ]
];
fhir:ExplanationOfBenefit.payee [
fhir:ExplanationOfBenefit.payee.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ];
fhir:Coding.code [ fhir:value "provider" ]
]
];
fhir:ExplanationOfBenefit.payee.party [
fhir:Reference.reference [ fhir:value "Organization/2" ]
]
];
fhir:ExplanationOfBenefit.facility [
fhir:Reference.reference [ fhir:value "Location/1" ]
];
fhir:ExplanationOfBenefit.claim [
fhir:Reference.reference [ fhir:value "Claim/100150" ]
];
fhir:ExplanationOfBenefit.claimResponse [
fhir:Reference.reference [ fhir:value "ClaimResponse/R3500" ]
];
fhir:ExplanationOfBenefit.outcome [ fhir:value "complete"];
fhir:ExplanationOfBenefit.disposition [ fhir:value "Claim settled as per contract."];
fhir:ExplanationOfBenefit.careTeam [
fhir:index 0;
fhir:ExplanationOfBenefit.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.careTeam.provider [
fhir:Reference.reference [ fhir:value "Practitioner/example" ]
]
];
fhir:ExplanationOfBenefit.insurance [
fhir:index 0;
fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:ExplanationOfBenefit.insurance.coverage [
fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]
]
];
fhir:ExplanationOfBenefit.item [
fhir:index 0;
fhir:ExplanationOfBenefit.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.item.careTeamSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:ExplanationOfBenefit.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-USCLS" ];
fhir:Coding.code [ fhir:value "1205" ]
]
];
fhir:ExplanationOfBenefit.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
fhir:ExplanationOfBenefit.item.unitPrice [
fhir:Money.value [ fhir:value "135.57"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:ExplanationOfBenefit.item.net [
fhir:Money.value [ fhir:value "135.57"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:ExplanationOfBenefit.item.udi [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Device/example" ]
];
fhir:ExplanationOfBenefit.item.encounter [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Encounter/example" ]
];
fhir:ExplanationOfBenefit.item.adjudication [
fhir:index 0;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "eligible" ]
]
];
fhir:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "120.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 1;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "eligpercent" ]
]
];
fhir:ExplanationOfBenefit.item.adjudication.value [ fhir:value "0.80"^^xsd:decimal ]
], [
fhir:index 2;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "96.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
]
], [
fhir:index 1;
fhir:ExplanationOfBenefit.item.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.item.careTeamSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:ExplanationOfBenefit.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "group" ]
]
];
fhir:ExplanationOfBenefit.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
fhir:ExplanationOfBenefit.item.net [
fhir:Money.value [ fhir:value "200.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:ExplanationOfBenefit.item.adjudication [
fhir:index 0;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "180.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
];
fhir:ExplanationOfBenefit.item.detail [
fhir:index 0;
fhir:ExplanationOfBenefit.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.item.detail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "group" ]
]
];
fhir:ExplanationOfBenefit.item.detail.net [
fhir:Money.value [ fhir:value "200.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:ExplanationOfBenefit.item.detail.udi [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Device/example" ]
];
fhir:ExplanationOfBenefit.item.detail.adjudication [
fhir:index 0;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "180.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
];
fhir:ExplanationOfBenefit.item.detail.subDetail [
fhir:index 0;
fhir:ExplanationOfBenefit.item.detail.subDetail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.item.detail.subDetail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-USCLS" ];
fhir:Coding.code [ fhir:value "1205" ]
]
];
fhir:ExplanationOfBenefit.item.detail.subDetail.unitPrice [
fhir:Money.value [ fhir:value "200.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:ExplanationOfBenefit.item.detail.subDetail.net [
fhir:Money.value [ fhir:value "200.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:ExplanationOfBenefit.item.detail.subDetail.udi [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Device/example" ]
];
fhir:ExplanationOfBenefit.item.detail.subDetail.adjudication [
fhir:index 0;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "eligible" ]
]
];
fhir:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "200.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 1;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "eligpercent" ]
]
];
fhir:ExplanationOfBenefit.item.adjudication.value [ fhir:value "0.90"^^xsd:decimal ]
], [
fhir:index 2;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "180.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
]
]
]
];
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 "135.57"^^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 "96.00"^^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 11:08+1000.
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