QI-Core Implementation Guide
5.0.0-ballot - STU Ballot US

This page is part of the Quality Improvement Core Framework (v5.0.0-ballot: STU 5 Ballot 1) based on FHIR R4. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

: ClaimResponse 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:Resource.id [ fhir:value "example"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</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 ClaimResponse \"example\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-qicore-claimresponse.html\">QICore Claim Response</a></p></div><p><b>status</b>: active</p><p><b>type</b>: Vision <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>#vision)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"Patient-example.html\">Patient/example</a> \" CHALMERS\"</p><p><b>created</b>: 2018-02-24</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization/example</a> \"Health Level Seven International\"</p><p><b>requestor</b>: <a href=\"Practitioner-example.html\">Practitioner/example</a> \" CAREFUL\"</p><p><b>request</b>: <a href=\"Claim-example.html\">Claim/example</a></p><p><b>outcome</b>: queued</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: 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></p></blockquote></blockquote></div>"
  ];
  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 "vision" ]     ]
  ];
  fhir:ClaimResponse.use [ fhir:value "preauthorization"];
  fhir:ClaimResponse.patient [
     fhir:Reference.reference [ fhir:value "Patient/example" ]
  ];
  fhir:ClaimResponse.created [ fhir:value "2018-02-24"^^xsd:date];
  fhir:ClaimResponse.insurer [
     fhir:Reference.reference [ fhir:value "Organization/example" ]
  ];
  fhir:ClaimResponse.requestor [
     fhir:Reference.reference [ fhir:value "Practitioner/example" ]
  ];
  fhir:ClaimResponse.request [
     fhir:Reference.reference [ fhir:value "Claim/example" ]
  ];
  fhir:ClaimResponse.outcome [ fhir:value "queued"];
  fhir:ClaimResponse.item [
     fhir:index 0;
     fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ClaimResponse.item.adjudication [
       fhir:index 0;
       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" ]         ]       ];
       fhir:ClaimResponse.item.adjudication.amount [
         fhir:Money.value [ fhir:value "235.40"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ]     ]
  ].

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

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