Da Vinci Prior Authorization Support (PAS) FHIR IG
1.1.0 - STU 1

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.1.0: STU 1.1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: PAS Claim Inquiry ResponseExample - 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 "PASClaimInquiryResponseExample"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse>     ]
  ];
  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 \"PASClaimInquiryResponseExample\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-claiminquiryresponse.html\">PAS Claim Inquiry Response</a></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/3.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"Patient-SubscriberExample.html\">Patient/SubscriberExample</a> \" SMITH\"</p><p><b>created</b>: 2019-07-20T11:01:00+05:00</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization/InsurerExample</a> \"MARYLAND CAPITAL INSURANCE COMPANY\"</p><p><b>outcome</b>: complete</p><blockquote><p><b>item</b></p><p><b>ItemAuthorizedDate</b>: 2005-05-02 --&gt; 2005-06-02</p><p><b>itemSequence</b>: 1</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/3.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></td></tr></table></blockquote><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-InsuranceExample.html\">Coverage/InsuranceExample</a></td></tr></table></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:Reference.reference [ fhir:value "Patient/SubscriberExample" ]
  ];
  fhir:ClaimResponse.created [ fhir:value "2019-07-20T11:01:00+05:00"^^xsd:dateTime];
  fhir:ClaimResponse.insurer [
     fhir:Reference.reference [ fhir:value "Organization/InsurerExample" ]
  ];
  fhir:ClaimResponse.outcome [ fhir:value "complete"];
  fhir:ClaimResponse.item [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/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:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ClaimResponse.item.adjudication [
       fhir:index 0;
       fhir:Element.extension [
         fhir:index 0;
         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-pas/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:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction" ]       ];
       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.insurance [
     fhir:index 0;
     fhir:ClaimResponse.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ClaimResponse.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:ClaimResponse.insurance.coverage [
       fhir:Reference.reference [ fhir:value "Coverage/InsuranceExample" ]     ]
  ].

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

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