Release 4

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Claimresponse-example-2.ttl

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Patient, Practitioner

Raw Turtle (+ also see Turtle/RDF Format Specification)

A ClaimResponse for a Claim that contains processing 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/ClaimResponse/R3501> a fhir:ClaimResponse;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "R3501"];
  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 ClaimResponse that demonstrates returning errors</div>"
  ];
  fhir:ClaimResponse.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/remittance" ];
     fhir:Identifier.value [ fhir:value "R3501" ]
  ];
  fhir:ClaimResponse.status [ fhir:value "active"];
  fhir:ClaimResponse.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:ClaimResponse.use [ fhir:value "claim"];
  fhir:ClaimResponse.patient [
     fhir:link <http://hl7.org/fhir/Patient/1>;
     fhir:Reference.reference [ fhir:value "Patient/1" ]
  ];
  fhir:ClaimResponse.created [ fhir:value "2014-08-16"^^xsd:date];
  fhir:ClaimResponse.insurer [
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "http://www.jurisdiction.org/insurers" ];
       fhir:Identifier.value [ fhir:value "555123" ]
     ]
  ];
  fhir:ClaimResponse.requestor [
     fhir:link <http://hl7.org/fhir/Practitioner/1>;
     fhir:Reference.reference [ fhir:value "Practitioner/1" ]
  ];
  fhir:ClaimResponse.request [
     fhir:link <http://hl7.org/fhir/Claim/100156>;
     fhir:Reference.reference [ fhir:value "Claim/100156" ]
  ];
  fhir:ClaimResponse.outcome [ fhir:value "error"];
  fhir:ClaimResponse.disposition [ fhir:value "Claim could not be processed"];
  fhir:ClaimResponse.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:ClaimResponse.processNote [
     fhir:index 0;
     fhir:ClaimResponse.processNote.number [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ClaimResponse.processNote.type [ fhir:value "display" ];
     fhir:ClaimResponse.processNote.text [ fhir:value "Invalid claim" ];
     fhir:ClaimResponse.processNote.language [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "urn:ietf:bcp:47" ];
         fhir:Coding.code [ fhir:value "en-CA" ]
       ]
     ]
  ];
  fhir:ClaimResponse.communicationRequest [
     fhir:index 0;
     fhir:link <http://hl7.org/fhir/CommunicationRequest/fm-solicit>;
     fhir:Reference.reference [ fhir:value "CommunicationRequest/fm-solicit" ]
  ];
  fhir:ClaimResponse.error [
     fhir:index 0;
     fhir:ClaimResponse.error.itemSequence [ fhir:value "3"^^xsd:positiveInteger ];
     fhir:ClaimResponse.error.detailSequence [ fhir:value "2"^^xsd:positiveInteger ];
     fhir:ClaimResponse.error.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication-error" ];
         fhir:Coding.code [ fhir:value "a002" ]
       ]
     ]
  ] .

<http://hl7.org/fhir/Patient/1> a fhir:Patient .

<http://hl7.org/fhir/Practitioner/1> a fhir:Practitioner .

<http://hl7.org/fhir/Claim/100156> a fhir:Claim .

<http://hl7.org/fhir/CommunicationRequest/fm-solicit> a fhir:CommunicationRequest .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/ClaimResponse/R3501.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/ClaimResponse/R3501.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.