R4 Draft for Comment
FinancialThis page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
. Page versions: R5 R4B R4
| Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Encounter, Patient, Practitioner, RelatedPerson |
EOB for an Claim that had errors
@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 -------------------------------------------------------------------
<http://hl7.org/fhir/ExplanationOfBenefit/EB3501> a fhir:ExplanationOfBenefit;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "EB3501"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ExplanationOfBenefit for a cliam that had errors, various other attributes (such as accident and hospitaliztion) are also completed.</div>"
];
fhir:ExplanationOfBenefit.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/explanationofbenefit" ];
fhir:Identifier.value [ fhir:value "error-1" ]
];
fhir:ExplanationOfBenefit.status [ fhir:value "active"];
fhir:ExplanationOfBenefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ex-claimtype" ];
fhir:Coding.code [ fhir:value "oral" ]
]
];
fhir:ExplanationOfBenefit.subType [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ex-claimsubtype" ];
fhir:Coding.code [ fhir:value "emergency" ]
]
];
fhir:ExplanationOfBenefit.patient [
fhir:link <http://hl7.org/fhir/Patient/pat1>;
fhir:Reference.reference [ fhir:value "Patient/pat1" ]
];
fhir:ExplanationOfBenefit.billablePeriod [
fhir:Period.start [ fhir:value "2014-02-01"^^xsd:date ];
fhir:Period.end [ fhir:value "2014-03-01"^^xsd:date ]
];
fhir:ExplanationOfBenefit.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:ExplanationOfBenefit.enterer [
fhir:link <http://hl7.org/fhir/Practitioner/1>;
fhir:Reference.reference [ fhir:value "Practitioner/1" ]
];
fhir:ExplanationOfBenefit.insurer [
fhir:link <http://hl7.org/fhir/Organization/2>;
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:ExplanationOfBenefit.provider [
fhir:link <http://hl7.org/fhir/Practitioner/1>;
fhir:Reference.reference [ fhir:value "Practitioner/1" ]
];
fhir:ExplanationOfBenefit.organization [
fhir:link <http://hl7.org/fhir/Organization/2>;
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:ExplanationOfBenefit.facility [
fhir:link <http://hl7.org/fhir/Location/1>;
fhir:Reference.reference [ fhir:value "Location/1" ]
];
fhir:ExplanationOfBenefit.claim [
fhir:link <http://hl7.org/fhir/Claim/100150>;
fhir:Reference.reference [ fhir:value "Claim/100150" ]
];
fhir:ExplanationOfBenefit.claimResponse [
fhir:link <http://hl7.org/fhir/ClaimResponse/R3500>;
fhir:Reference.reference [ fhir:value "ClaimResponse/R3500" ]
];
fhir:ExplanationOfBenefit.outcome [ fhir:value "error"];
fhir:ExplanationOfBenefit.disposition [ fhir:value "Could not process."];
fhir:ExplanationOfBenefit.related [
fhir:index 0;
fhir:ExplanationOfBenefit.related.reference [
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/case-number" ];
fhir:Identifier.value [ fhir:value "23-56Tu-XX-47-20150M14" ]
]
];
fhir:ExplanationOfBenefit.prescription [
fhir:link <http://hl7.org/fhir/MedicationRequest/medrx002>;
fhir:Reference.reference [ fhir:value "MedicationRequest/medrx002" ]
];
fhir:ExplanationOfBenefit.originalPrescription [
fhir:link <http://hl7.org/fhir/MedicationRequest/medrx0301>;
fhir:Reference.reference [ fhir:value "MedicationRequest/medrx0301" ]
];
fhir:ExplanationOfBenefit.procedure [
fhir:index 0;
fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2014-02-14"^^xsd:date ];
fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ];
fhir:Coding.code [ fhir:value "123001" ]
]
]
];
fhir:ExplanationOfBenefit.precedence [ fhir:value "2"^^xsd:positiveInteger];
fhir:ExplanationOfBenefit.insurance [
fhir:ExplanationOfBenefit.insurance.coverage [
fhir:link <http://hl7.org/fhir/Coverage/9876B1>;
fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]
]
];
fhir:ExplanationOfBenefit.accident [
fhir:ExplanationOfBenefit.accident.date [ fhir:value "2014-02-14"^^xsd:date ];
fhir:ExplanationOfBenefit.accident.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/v3/ActCode" ];
fhir:Coding.code [ fhir:value "SPT" ]
]
];
fhir:ExplanationOfBenefit.accident.locationReference [
fhir:link <http://hl7.org/fhir/Location/ph>;
fhir:Reference.reference [ fhir:value "Location/ph" ]
]
];
fhir:ExplanationOfBenefit.employmentImpacted [
fhir:Period.start [ fhir:value "2014-02-14"^^xsd:date ];
fhir:Period.end [ fhir:value "2014-02-28"^^xsd:date ]
];
fhir:ExplanationOfBenefit.hospitalization [
fhir:Period.start [ fhir:value "2014-02-14"^^xsd:date ];
fhir:Period.end [ fhir:value "2014-02-16"^^xsd:date ]
];
fhir:ExplanationOfBenefit.totalCost [
fhir:Quantity.value [ fhir:value "2478.57"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ]
];
fhir:ExplanationOfBenefit.totalBenefit [
fhir:Quantity.value [ fhir:value "0.00"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ]
];
fhir:ExplanationOfBenefit.form [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/forms-codes" ];
fhir:Coding.code [ fhir:value "2" ]
]
];
fhir:ExplanationOfBenefit.processNote [
fhir:index 0;
fhir:ExplanationOfBenefit.processNote.number [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.processNote.type [ fhir:value "display" ];
fhir:ExplanationOfBenefit.processNote.text [ fhir:value "Invalid claim" ];
fhir:ExplanationOfBenefit.processNote.language [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "urn:ietf:bcp:47" ];
fhir:Coding.code [ fhir:value "en-CA" ]
]
]
] .
<http://hl7.org/fhir/Patient/pat1> a fhir:Patient .
<http://hl7.org/fhir/Practitioner/1> a fhir:Practitioner .
<http://hl7.org/fhir/Organization/2> a fhir:Organization .
<http://hl7.org/fhir/Location/1> a fhir:Location .
<http://hl7.org/fhir/Claim/100150> a fhir:Claim .
<http://hl7.org/fhir/ClaimResponse/R3500> a fhir:ClaimResponse .
<http://hl7.org/fhir/MedicationRequest/medrx002> a fhir:MedicationRequest .
<http://hl7.org/fhir/MedicationRequest/medrx0301> a fhir:MedicationRequest .
<http://hl7.org/fhir/Coverage/9876B1> a fhir:Coverage .
<http://hl7.org/fhir/Location/ph> a fhir:Location .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/ExplanationOfBenefit/EB3501.ttl> a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI <http://build.fhir.org/ExplanationOfBenefit/EB3501.ttl> .
# -------------------------------------------------------------------------------------
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.
®© HL7.org 2011+. FHIR Release 4 Draft for Comment (Jan-2018 v3.2.0-12885) generated on Wed, Dec 20, 2017 15:57+1100. QA Page
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