Release 5
This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version in it's permanent home (it will always be available at this URL). 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:id [ fhir:v "660152"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Vision Claim for Glasses</div>"
] ; #
fhir:contained ( [
a fhir:Device ;
fhir:id [ fhir:v "device-frame" ]
] [
a fhir:Device ;
fhir:id [ fhir:v "device-lens" ]
] ) ; # rest of the resource omitted for brevity
fhir:identifier ( [
fhir:system [ fhir:v "http://happysight.com/claim"^^xsd:anyURI ] ;
fhir:value [ fhir:v "6612347" ]
] ) ; #
fhir:status [ fhir:v "active"] ; #
fhir:type [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "vision" ]
] )
] ; #
fhir:use [ fhir:v "claim"] ; #
fhir:patient [
fhir:reference [ fhir:v "Patient/1" ]
] ; #
fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; #
fhir:insurer [
fhir:reference [ fhir:v "Organization/2" ]
] ; #
fhir:provider [
fhir:reference [ fhir:v "Organization/1" ]
] ; #
fhir:priority [
fhir:coding ( [
fhir:code [ fhir:v "normal" ]
] )
] ; #
fhir:prescription [
fhir:link <http://www.optdocs.com/prescription/12345> ;
fhir:reference [ fhir:v "http://www.optdocs.com/prescription/12345" ]
] ; #
fhir:payee [
fhir:type [
fhir:coding ( [
fhir:code [ fhir:v "provider" ]
] )
]
] ; #
fhir:careTeam ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:provider [
fhir:reference [ fhir:v "Practitioner/example" ]
]
] ) ; #
fhir:diagnosis ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:diagnosis [
a fhir:CodeableConcept ;
fhir:coding ( [
fhir:code [ fhir:v "654321" ]
] )
]
] ) ; #
fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; # Patient's own coverage - primary
fhir:focal [ fhir:v "false"^^xsd:boolean ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/9876B1" ]
] ;
fhir:preAuthRef ( [ fhir:v "PR7652387237" ] ) ;
fhir:claimResponse [
fhir:reference [ fhir:v "ClaimResponse/R3500" ]
]
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; # Spouses's own coverage - secondary
fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/9876B1" ]
] ;
fhir:preAuthRef ( [ fhir:v "AB543GTD7567" ] )
] ) ; #
fhir:item ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:revenue [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
fhir:code [ fhir:v "0010" ] ;
fhir:display [ fhir:v "Vision Clinic" ]
] )
] ;
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "F6" ] ;
fhir:display [ fhir:v "Vision Coverage" ]
] )
] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "glasses" ]
] )
] ;
fhir:modifier ( [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
fhir:code [ fhir:v "rooh" ]
] )
] ) ;
fhir:programCode ( [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-programcode"^^xsd:anyURI ] ;
fhir:code [ fhir:v "none" ]
] )
] ) ;
fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
fhir:unitPrice [
fhir:value [ fhir:v "235.40"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "235.40"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:detail ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:revenue [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
fhir:code [ fhir:v "0010" ] ;
fhir:display [ fhir:v "Vision Clinic" ]
] )
] ;
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "F6" ] ;
fhir:display [ fhir:v "Vision Coverage" ]
] )
] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "frame" ]
] )
] ;
fhir:modifier ( [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
fhir:code [ fhir:v "rooh" ]
] )
] ) ;
fhir:unitPrice [
fhir:value [ fhir:v "100.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:factor [ fhir:v "1.1"^^xsd:decimal ] ;
fhir:net [
fhir:value [ fhir:v "110.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ; # 10% surcharge for out of hours work
fhir:udi ( [
fhir:reference [ fhir:v "#device-frame" ]
] )
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:revenue [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
fhir:code [ fhir:v "0010" ] ;
fhir:display [ fhir:v "Vision Clinic" ]
] )
] ;
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "F6" ] ;
fhir:display [ fhir:v "Vision Coverage" ]
] )
] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "lens" ]
] )
] ;
fhir:programCode ( [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-programcode"^^xsd:anyURI ] ;
fhir:code [ fhir:v "none" ]
] )
] ) ;
fhir:quantity [
fhir:value [ fhir:v "2"^^xsd:decimal ]
] ;
fhir:unitPrice [
fhir:value [ fhir:v "55.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "110.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:subDetail ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:revenue [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
fhir:code [ fhir:v "0010" ] ;
fhir:display [ fhir:v "Vision Clinic" ]
] )
] ;
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "F6" ] ;
fhir:display [ fhir:v "Vision Coverage" ]
] )
] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "lens" ]
] )
] ;
fhir:modifier ( [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
fhir:code [ fhir:v "rooh" ]
] )
] ) ;
fhir:programCode ( [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-programcode"^^xsd:anyURI ] ;
fhir:code [ fhir:v "none" ]
] )
] ) ;
fhir:quantity [
fhir:value [ fhir:v "2"^^xsd:decimal ]
] ;
fhir:unitPrice [
fhir:value [ fhir:v "30.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:factor [ fhir:v "1.1"^^xsd:decimal ] ;
fhir:net [
fhir:value [ fhir:v "66.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ; # 10% surchage for out of hours work
fhir:udi ( [
fhir:reference [ fhir:v "#device-lens" ]
] )
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:revenue [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
fhir:code [ fhir:v "0010" ] ;
fhir:display [ fhir:v "Vision Clinic" ]
] )
] ;
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "F6" ] ;
fhir:display [ fhir:v "Vision Coverage" ]
] )
] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "hardening" ]
] )
] ;
fhir:modifier ( [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
fhir:code [ fhir:v "rooh" ]
] )
] ) ;
fhir:quantity [
fhir:value [ fhir:v "2"^^xsd:decimal ]
] ;
fhir:unitPrice [
fhir:value [ fhir:v "15.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:factor [ fhir:v "1.1"^^xsd:decimal ] ;
fhir:net [
fhir:value [ fhir:v "33.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] # 10% surchage for out of hours work
] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
fhir:revenue [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
fhir:code [ fhir:v "0010" ] ;
fhir:display [ fhir:v "Vision Clinic" ]
] )
] ;
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "F6" ] ;
fhir:display [ fhir:v "Vision Coverage" ]
] )
] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "UV coating" ]
] )
] ;
fhir:modifier ( [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/modifiers"^^xsd:anyURI ] ;
fhir:code [ fhir:v "rooh" ]
] )
] ) ;
fhir:quantity [
fhir:value [ fhir:v "2"^^xsd:decimal ]
] ;
fhir:unitPrice [
fhir:value [ fhir:v "5.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:factor [ fhir:v "1.1"^^xsd:decimal ] ;
fhir:net [
fhir:value [ fhir:v "11.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] # 10% surchage for out of hours work
] )
] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
fhir:revenue [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-revenue-center"^^xsd:anyURI ] ;
fhir:code [ fhir:v "0010" ] ;
fhir:display [ fhir:v "Vision Clinic" ]
] )
] ;
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/benefit-subcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "F6" ] ;
fhir:display [ fhir:v "Vision Coverage" ]
] )
] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "fst" ]
] )
] ;
fhir:unitPrice [
fhir:value [ fhir:v "220.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:factor [ fhir:v "0.07"^^xsd:decimal ] ;
fhir:net [
fhir:value [ fhir:v "15.40"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] )
] )] . #
# -------------------------------------------------------------------------------------
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 hl7.fhir.core#5.0.0 generated on Sun, Mar 26, 2023 15:24+1100.
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