Da Vinci Health Record Exchange (HRex)
1.0.0 - STU R1 US

This page is part of the Da Vinci Health Record Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: Unsolicited Prior Authorization example - TTL Representation

Page standards status: Informative

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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:Resource.id [ fhir:value "UnsolicitedReferralAuthorizationResponseExample"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"UnsolicitedReferralAuthorizationResponseExample\" </p></div><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"http://example.org/new-payer/fhir/Patient/pat1\">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/full</a> \"New Health Plan\"</p><p><b>requestor</b>: <a href=\"http://example.org/someProvider/fhir/Organization/good-health-clinic\">http://example.org/someProvider/fhir/Organization/good-health-clinic</a></p><p><b>outcome</b>: complete</p><p><b>preAuthRef</b>: A1B2C3D4</p><blockquote><p><b>addItem</b></p><p><b>Authorized Date</b>: 2005-05-02 --&gt; 2005-06-02</p><p><b>Pre Authorized Issue Date</b>: 2005-05-02</p><p><b>Authorized Provider</b>: <a href=\"Practitioner-full.html\">Practitioner/full</a> \" BONE\"</p><p><b>Item Trace Number</b>: id: A1B2C3D4</p><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1365#3)</span></p><p><b>location</b>: 11 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-CMSPlaceofServiceCodes.html\">CMS Place of Service Codes (POS)</a>#11)</span></p><h3>Adjudications</h3><table class=\"grid\"><tr><td>-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td>*</td><td></td><td>Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></td></tr></table></blockquote></div>"
  ];
  fhir:ClaimResponse.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://example.org/PATIENT_EVENT_TRACE_NUMBER" ];
     fhir:Identifier.value [ fhir:value "111099" ];
     fhir:Identifier.assigner [
       fhir:Reference.identifier [
         fhir:Identifier.system [ fhir:value "http://example.org/USER_ASSIGNED" ];
         fhir:Identifier.value [ fhir:value "9012345678" ]       ]     ]
  ];
  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 "professional" ]     ]
  ];
  fhir:ClaimResponse.use [ fhir:value "preauthorization"];
  fhir:ClaimResponse.patient [
     fhir:link <http://example.org/new-payer/fhir/Patient/pat1>;
     fhir:Reference.reference [ fhir:value "http://example.org/new-payer/fhir/Patient/pat1" ]
  ];
  fhir:ClaimResponse.created [ fhir:value "2005-05-02T11:02:00+05:00"^^xsd:dateTime];
  fhir:ClaimResponse.insurer [
     fhir:Reference.reference [ fhir:value "Organization/full" ]
  ];
  fhir:ClaimResponse.requestor [
     fhir:link <http://example.org/someProvider/fhir/Organization/good-health-clinic>;
     fhir:Reference.reference [ fhir:value "http://example.org/someProvider/fhir/Organization/good-health-clinic" ]
  ];
  fhir:ClaimResponse.outcome [ fhir:value "complete"];
  fhir:ClaimResponse.preAuthRef [ fhir:value "A1B2C3D4"];
  fhir:ClaimResponse.addItem [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate" ];
       fhir:Extension.valuePeriod [
         fhir:Period.start [ fhir:value "2005-05-02"^^xsd:date ];
         fhir:Period.end [ fhir:value "2005-06-02"^^xsd:date ]       ]     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate" ];
       fhir:Extension.valueDate [ fhir:value "2005-05-02"^^xsd:date ]     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider" ];
       fhir:Extension.valueReference [
         fhir:Reference.reference [ fhir:value "Practitioner/full" ]       ]     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber" ];
       fhir:Extension.valueIdentifier [
         fhir:Identifier.system [ fhir:value "http://example.org/new-payer/fhir/NamingSystem/auth-numbers" ];
         fhir:Identifier.value [ fhir:value "A1B2C3D4" ]       ]     ];
     fhir:ClaimResponse.addItem.itemSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0     ];
     fhir:ClaimResponse.addItem.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/1365" ];
         fhir:Coding.code [ fhir:value "3" ];
         fhir:Coding.display [ fhir:value "Consultation" ]       ]     ];
     fhir:ClaimResponse.addItem.locationCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set" ];
         fhir:Coding.code [ fhir:value "11" ]       ]     ];
     fhir:ClaimResponse.addItem.adjudication [
       fhir:index 0;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-reviewAction" ];
         fhir:Element.extension [
           fhir:index 0;
           fhir:Extension.url [ fhir:value "number" ];
           fhir:Extension.valueString [ fhir:value "AUTH0001" ]         ], [
           fhir:index 1;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-reviewActionCode" ];
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index 0;
               fhir:Coding.system [ fhir:value "http://codesystem.x12.org/005010/306" ];
               fhir:Coding.code [ fhir:value "A1" ];
               fhir:Coding.display [ fhir:value "Certified in total" ]             ]           ]         ]       ];
       fhir:ClaimResponse.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ];
           fhir:Coding.code [ fhir:value "submitted" ]         ]       ]     ]
  ].

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

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.