FHIR Release 3 (STU)
FinancialThis page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
| Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Practitioner |
General Person Primary Coverage with Benefit Details and new insurance
@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/EligibilityResponse/E2502> a fhir:EligibilityResponse;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "E2502"];
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 EligibilityResponse.</div>"
];
fhir:DomainResource.contained [
a fhir:Patient;
fhir:index 0;
fhir:Resource.id [ fhir:value "patient-1" ];
fhir:Patient.name [
fhir:index 0;
fhir:HumanName.use [ fhir:value "official" ];
fhir:HumanName.family [ fhir:value "Donald" ];
fhir:HumanName.given [
fhir:value "Duck";
fhir:index 0
]
];
fhir:Patient.gender [ fhir:value "male" ];
fhir:Patient.birthDate [ fhir:value "1986-05-17"^^xsd:date ];
fhir:Patient.address [
fhir:index 0;
fhir:Address.use [ fhir:value "home" ];
fhir:Address.line [
fhir:value "1234 Main Street";
fhir:index 0
];
fhir:Address.city [ fhir:value "Vancouver" ];
fhir:Address.postalCode [ fhir:value "V2H1Y3" ];
fhir:Address.country [ fhir:value "CAD" ]
]
], [
a fhir:Coverage;
fhir:index 1;
fhir:Resource.id [ fhir:value "coverage-1" ];
fhir:Coverage.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://benefitsinc.com/certificate" ];
fhir:Identifier.value [ fhir:value "12345" ]
];
fhir:Coverage.status [ fhir:value "active" ];
fhir:Coverage.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/v3/ActCode" ];
fhir:Coding.code [ fhir:value "EHCPOL" ]
]
];
fhir:Coverage.subscriber [
fhir:Reference.reference [ fhir:value "#patient-1" ]
];
fhir:Coverage.beneficiary [
fhir:Reference.reference [ fhir:value "#patient-1" ]
];
fhir:Coverage.relationship [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "self" ]
]
];
fhir:Coverage.payor [
fhir:index 0;
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://www.bindb.com/bin" ];
fhir:Identifier.value [ fhir:value "123456" ]
]
];
fhir:Coverage.grouping [
fhir:Coverage.grouping.plan [ fhir:value "CBI35" ];
fhir:Coverage.grouping.planDisplay [ fhir:value "Corporate Baker's Inc. Plan#35" ];
fhir:Coverage.grouping.subPlan [ fhir:value "123" ];
fhir:Coverage.grouping.subPlanDisplay [ fhir:value "Trainee Part-time Benefits" ]
];
fhir:Coverage.dependent [ fhir:value "1" ];
fhir:Coverage.sequence [ fhir:value "1" ]
];
fhir:EligibilityResponse.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/eligibilityresponse" ];
fhir:Identifier.value [ fhir:value "8812342" ]
];
fhir:EligibilityResponse.status [ fhir:value "active"];
fhir:EligibilityResponse.created [ fhir:value "2014-09-16"^^xsd:date];
fhir:EligibilityResponse.requestProvider [
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://national.org/provider" ];
fhir:Identifier.value [ fhir:value "PR9876" ]
]
];
fhir:EligibilityResponse.requestOrganization [
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://national.org/clinic" ];
fhir:Identifier.value [ fhir:value "OR1234" ]
]
];
fhir:EligibilityResponse.request [
fhir:link <http://www.BenefitsInc.com/fhir/eligibility/225476332405>;
fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/eligibility/225476332405" ]
];
fhir:EligibilityResponse.outcome [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/remittance-outcome" ];
fhir:Coding.code [ fhir:value "complete" ]
]
];
fhir:EligibilityResponse.disposition [ fhir:value "Policy is currently in-force."];
fhir:EligibilityResponse.insurer [
fhir:link <http://hl7.org/fhir/Organization/2>;
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:EligibilityResponse.inforce [ fhir:value "true"^^xsd:boolean];
fhir:EligibilityResponse.insurance [
fhir:index 0;
fhir:EligibilityResponse.insurance.coverage [
fhir:Reference.reference [ fhir:value "#coverage-1" ]
];
fhir:EligibilityResponse.insurance.contract [
fhir:link <http://www.BenefitsInc.com/fhir/contract/NBU22547>;
fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/contract/NBU22547" ]
];
fhir:EligibilityResponse.insurance.benefitBalance [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
fhir:Coding.code [ fhir:value "medical" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "30" ];
fhir:Coding.display [ fhir:value "Health Benefit Plan Coverage" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "500000"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.usedMoney [
fhir:Quantity.value [ fhir:value "3748.00"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ]
]
], [
fhir:index 1;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "copay-maximum" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "100"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ]
]
], [
fhir:index 2;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "copay-percent" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ]
]
], [
fhir:index 1;
fhir:EligibilityResponse.insurance.benefitBalance.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
fhir:Coding.code [ fhir:value "medical" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "69" ];
fhir:Coding.display [ fhir:value "Maternity" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "15000"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ]
]
]
], [
fhir:index 2;
fhir:EligibilityResponse.insurance.benefitBalance.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
fhir:Coding.code [ fhir:value "oral" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F3" ];
fhir:Coding.display [ fhir:value "Dental Coverage" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "2000"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ]
]
]
], [
fhir:index 3;
fhir:EligibilityResponse.insurance.benefitBalance.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
fhir:Coding.code [ fhir:value "vision" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.excluded [ fhir:value "true"^^xsd:boolean ];
fhir:EligibilityResponse.insurance.benefitBalance.name [ fhir:value "Vision" ];
fhir:EligibilityResponse.insurance.benefitBalance.description [ fhir:value "Vision products and services such as exams, glasses and contatc lenses." ]
]
];
fhir:EligibilityResponse.form [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://national.org/form" ];
fhir:Coding.code [ fhir:value "ELRSP/2017/01" ]
]
] .
<http://hl7.org/fhir/Organization/2> a fhir:Organization .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/EligibilityResponse/E2502.ttl> a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI <http://hl7.org/fhir/STU3/EligibilityResponse/E2502.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 Release 3 (STU; v3.0.2-11200) generated on Thurs, Oct 24, 2019 11:53+1100. QA Page
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