Patient Cost Transparency Implementation Guide
0.1.0 - STU 1 Ballot

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v0.1.0: STU 1 Draft) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

: PCT-GFE-Institutional-1 - 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:Claim;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "PCT-GFE-Institutional-1"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/pct-gfe-Institutional";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/pct-gfe-Institutional>     ]
  ];
  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 \"PCT-GFE-Institutional-1\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-pct-gfe-Institutional.html\">PCT Good Faith Estimate Institutional</a></p></div><p><b>GFESubmitter</b>: <a href=\"Organization-Submitter-Org-1.html\">Organization/Submitter-Org-1</a> \"GFE Service Help INC.\"</p><p><b>GFEProviderAssignedIdentifier</b>: id: GFEProviderAssignedID0001</p><p><b>ProviderEventMethodology</b>: EEMM1021</p><p><b>InterTransIdentifier</b>: id: InterTransID0001</p><blockquote><p><b>GFEServiceLinkingInfo</b></p><p><b>value</b>: 223452-2342-2435-008001</p><p><b>value</b>: 2021-10-31</p></blockquote><p><b>status</b>: active</p><p><b>type</b>: Institutional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/2.1.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#institutional)</span></p><p><b>use</b>: predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Patient/patient1001</a> \" BETTERHALF\"</p><p><b>created</b>: 2021-10-05</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> \"Umbrella Insurance Company\"</p><p><b>provider</b>: <a href=\"Organization-org1002.html\">Organization/org1002</a> \"Boston Radiology Center\"</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/2.1.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><h3>Payees</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td></tr><tr><td>*</td><td>Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/2.1.0/CodeSystem-payeetype.html\">ClaimPayeeTypeCodes</a>#provider)</span></td></tr></table><p><b>referral</b>: <span>: Referral Number</span></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td><td><b>PackageCode</b></td></tr><tr><td>*</td><td>1</td><td>Unspecified focal traumatic brain injury <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/2.1.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#S06.30)</span></td><td>Principal Diagnosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/2.1.0/CodeSystem-ex-diagnosistype.html\">Example Diagnosis Type Codes</a>#principal)</span></td><td>Head trauma - concussion <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/2.1.0/CodeSystem-ex-diagnosisrelatedgroup.html\">Example Diagnosis Related Group Codes</a>#400)</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage/coverage1001</a></td></tr></table><blockquote><p><b>item</b></p><p><b>EstimatedDateOfService</b>: 2021-10-31</p><p><b>sequence</b>: 1</p><p><b>revenue</b>: Revenue Code 1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PCTGFEItemRevenueCS.html\">PCT GFE Item Revenue Code System</a>#2011)</span></p><p><b>productOrService</b>: Some CPT Code 1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PCTGFEItemProcedureCodes.html\">PCT GFE Item Procedure Code System</a>#33502)</span></p><p><b>modifier</b>: Some CPT Code 2 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PCTGFEItemProcedureCodes.html\">PCT GFE Item Procedure Code System</a>#34503)</span></p><p><b>quantity</b>: 1</p><h3>Details</h3><table class=\"grid\"><tr><td>-</td><td><b>Extension</b></td><td><b>Sequence</b></td><td><b>ProductOrService</b></td></tr><tr><td>*</td><td></td><td>1</td><td>nitroglycerin  (product) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/2.1.0/CodeSystem-v3-ndc.html\">National drug codes</a>#47781-457)</span></td></tr></table></blockquote></div>"
  ];
  fhir:DomainResource.extension [
     fhir:index 0;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeSubmitter" ];
     fhir:Extension.valueReference [
       fhir:Reference.reference [ fhir:value "Organization/Submitter-Org-1" ]     ]
  ], [
     fhir:index 1;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeProviderAssignedIdentifier" ];
     fhir:Extension.valueIdentifier [
       fhir:Identifier.value [ fhir:value "GFEProviderAssignedID0001" ]     ]
  ], [
     fhir:index 2;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology" ];
     fhir:Extension.valueString [ fhir:value "EEMM1021" ]
  ], [
     fhir:index 3;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/interTransIdentifier" ];
     fhir:Extension.valueIdentifier [
       fhir:Identifier.value [ fhir:value "InterTransID0001" ]     ]
  ], [
     fhir:index 4;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "linkingIdentifier" ];
       fhir:Extension.valueString [ fhir:value "223452-2342-2435-008001" ]     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "plannedPeriodOfService" ];
       fhir:Extension.valueDate [ fhir:value "2021-10-31"^^xsd:date ]     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo" ]
  ];
  fhir:Claim.status [ fhir:value "active"];
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "institutional" ];
       fhir:Coding.display [ fhir:value "Institutional" ]     ]
  ];
  fhir:Claim.use [ fhir:value "predetermination"];
  fhir:Claim.patient [
     fhir:Reference.reference [ fhir:value "Patient/patient1001" ]
  ];
  fhir:Claim.created [ fhir:value "2021-10-05"^^xsd:date];
  fhir:Claim.insurer [
     fhir:Reference.reference [ fhir:value "Organization/org1001" ]
  ];
  fhir:Claim.provider [
     fhir:Reference.reference [ fhir:value "Organization/org1002" ]
  ];
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
       fhir:Coding.code [ fhir:value "normal" ]     ]
  ];
  fhir:Claim.payee [
     fhir:Claim.payee.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ];
         fhir:Coding.code [ fhir:value "provider" ]       ]     ]
  ];
  fhir:Claim.referral [
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber" ];
       fhir:Extension.valueString [ fhir:value "REF12022002-121" ]     ];
     fhir:Reference.display [ fhir:value "Referral Number" ]
  ];
  fhir:Claim.diagnosis [
     fhir:index 0;
     fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
         fhir:Coding.code [ fhir:value "S06.30" ];
         fhir:Coding.display [ fhir:value "Unspecified focal traumatic brain injury" ]       ]     ];
     fhir:Claim.diagnosis.type [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ];
         fhir:Coding.code [ fhir:value "principal" ]       ]     ];
     fhir:Claim.diagnosis.packageCode [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup" ];
         fhir:Coding.code [ fhir:value "400" ];
         fhir:Coding.display [ fhir:value "Head trauma - concussion" ]       ]     ]
  ];
  fhir:Claim.insurance [
     fhir:index 0;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:Claim.insurance.coverage [
       fhir:Reference.reference [ fhir:value "Coverage/coverage1001" ]     ]
  ];
  fhir:Claim.item [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService" ];
       fhir:Extension.valueDate [ fhir:value "2021-10-31"^^xsd:date ]     ];
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.item.revenue [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTGFEItemRevenueCS" ];
         fhir:Coding.code [ fhir:value "2011" ];
         fhir:Coding.display [ fhir:value "Revenue Code 1" ]       ]     ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTGFEItemProcedureCodes" ];
         fhir:Coding.code [ fhir:value "33502" ];
         fhir:Coding.display [ fhir:value "Some CPT Code 1" ]       ]     ];
     fhir:Claim.item.modifier [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTGFEItemProcedureCodes" ];
         fhir:Coding.code [ fhir:value "34503" ];
         fhir:Coding.display [ fhir:value "Some CPT Code 2" ]       ]     ];
     fhir:Claim.item.quantity [
       fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ]     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "200"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ];
     fhir:Claim.item.detail [
       fhir:index 0;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/compoundDrugLinkingNum" ];
         fhir:Extension.valueInteger [ fhir:value "123456"^^xsd:integer ]       ];
       fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ndc" ];
           fhir:Coding.code [ fhir:value "47781-457" ]         ]       ]     ]
  ];
  fhir:Claim.total [
     fhir:Money.value [ fhir:value "200"^^xsd:decimal ];
     fhir:Money.currency [ fhir:value "USD" ]
  ].

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

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