This page is part of the Da Vinci Health Record Exchange (v1.1.0-ballot: STU 1.1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions
: Unsolicited Prior Authorization example - TTL Representation
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@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:ClaimResponse ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "UnsolicitedReferralAuthorizationResponseExample"] ; #
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-claimresponse"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-claimresponse> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse UnsolicitedReferralAuthorizationResponseExample</b></p><a name=\"UnsolicitedReferralAuthorizationResponseExample\"> </a><a name=\"hcUnsolicitedReferralAuthorizationResponseExample\"> </a><a name=\"UnsolicitedReferralAuthorizationResponseExample-en-US\"> </a><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&canonical=http://example.org/new-payer/fhir/Patient/pat1\">??</a></p><p><b>created</b>: 2005-05-02 11:02:00+0500</p><p><b>insurer</b>: <a href=\"Organization-full.html\">Organization New Health Plan</a></p><p><b>requestor</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&canonical=http://example.org/someProvider/fhir/Organization/good-health-clinic\">??</a></p><p><b>outcome</b>: Processing Complete</p><p><b>preAuthRef</b>: A1B2C3D4</p><blockquote><p><b>addItem</b></p><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://codesystem.x12.org/005010/1365 3}\">Consultation</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">11</span></p><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr></table></blockquote></div>"
] ; #
fhir:identifier ( [
fhir:system [ fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ] ;
fhir:value [ fhir:v "111099" ] ;
fhir:assigner [
fhir:identifier [
fhir:system [ fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ] ;
fhir:value [ fhir:v "9012345678" ] ] ]
] ) ; #
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 "professional" ] ] )
] ; #
fhir:use [ fhir:v "preauthorization"] ; #
fhir:patient [
fhir:link <http://example.org/new-payer/fhir/Patient/pat1> ;
fhir:reference [ fhir:v "http://example.org/new-payer/fhir/Patient/pat1" ]
] ; #
fhir:created [ fhir:v "2005-05-02T11:02:00+05:00"^^xsd:dateTime] ; #
fhir:insurer [
fhir:reference [ fhir:v "Organization/full" ]
] ; #
fhir:requestor [
fhir:link <http://example.org/someProvider/fhir/Organization/good-health-clinic> ;
fhir:reference [ fhir:v "http://example.org/someProvider/fhir/Organization/good-health-clinic" ]
] ; #
fhir:outcome [ fhir:v "complete"] ; #
fhir:preAuthRef [ fhir:v "A1B2C3D4"] ; #
fhir:addItem ( [
( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate"^^xsd:anyURI ] ;
fhir:value [
a fhir:Period ;
fhir:start [ fhir:v "2005-05-02"^^xsd:date ] ;
fhir:end [ fhir:v "2005-06-02"^^xsd:date ] ] ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate"^^xsd:anyURI ] ;
fhir:value [ fhir:v "2005-05-02"^^xsd:date ] ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:reference [ fhir:v "Practitioner/full" ] ] ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber"^^xsd:anyURI ] ;
fhir:value [
a fhir:Identifier ;
fhir:system [ fhir:v "http://example.org/new-payer/fhir/NamingSystem/auth-numbers"^^xsd:anyURI ] ;
fhir:value [ fhir:v "A1B2C3D4" ] ] ] ) ;
( fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
( fhir:coding [
fhir:system [ fhir:v "http://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
fhir:code [ fhir:v "3" ] ;
fhir:display [ fhir:v "Consultation" ] ] ) ] ;
fhir:location [
a fhir:CodeableConcept ;
( fhir:coding [
fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
fhir:code [ fhir:v "11" ] ] ) ] ;
( fhir:adjudication [
fhir:category [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "submitted" ] ] ) ] ] )
] ) . #
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