@prefix fhir: . @prefix owl: . @prefix rdf: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:ClaimResponse ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "PractitionerRequestorResponseExample"] ; # fhir:meta [ fhir:profile ( [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"^^xsd:anyURI ; fhir:l ] ) ] ; # fhir:language [ fhir:v "en"] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div [ fhir:v "

Generated Narrative: ClaimResponse PractitionerRequestorResponseExample

Language: en

Profile: PAS Claim Response

identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/111099

status: Active

type: Professional

use: Preauthorization

patient: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)

created: 2005-05-02 11:02:00+0500

insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY

requestor: PractitionerRole: telecom = ph: 4029993456

request: Claim: extension = Urgent,; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal

outcome: Complete

item

Item Requested Service Date: 2005-05-02 --> 2005-06-02

Item Preauthorization Issue Date: 2005-05-02

Item Preauthorization Period: 2005-05-02 --> 2005-06-02

Item Authorized Provider

Item Authorized Detail

  • productOrServiceCode: Consultation
  • unitPrice: $100.00 (USD)
  • quantity: 1

itemSequence: 1

Adjudications

-ExtensionCategory
*Submitted Amount
"^^rdf:XMLLiteral ] ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ; fhir:l ] ; fhir:value [ fhir:v "111099" ] ; fhir:assigner [ fhir:identifier [ fhir:system [ fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ; fhir:l ] ; fhir:value [ fhir:v "9012345678" ] ] ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "professional" ] ] ) ] ; # fhir:use [ fhir:v "preauthorization"] ; # fhir:patient [ fhir:l ; fhir:reference [ fhir:v "Patient/SubscriberExample" ] ] ; # fhir:created [ fhir:v "2005-05-02T11:02:00+05:00"^^xsd:dateTime] ; # fhir:insurer [ fhir:l ; fhir:reference [ fhir:v "Organization/InsurerExample" ] ] ; # fhir:requestor [ fhir:l ; fhir:reference [ fhir:v "PractitionerRole/ReferralPractitionerRoleExample" ] ] ; # fhir:request [ fhir:l ; fhir:reference [ fhir:v "Claim/ReferralAuthorizationExample" ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:item ( [ fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:Period ; fhir:start [ fhir:v "2005-05-02"^^xsd:date ] ; fhir:end [ fhir:v "2005-06-02"^^xsd:date ] ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:Date ; fhir:v "2005-05-02"^^xsd:date ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:Period ; fhir:start [ fhir:v "2005-05-02"^^xsd:date ] ; fhir:end [ fhir:v "2005-06-02"^^xsd:date ] ] ] [ fhir:extension ( [ fhir:url [ fhir:v "provider"^^xsd:anyURI ; fhir:l fhir:provider ] ; fhir:value [ a fhir:Reference ; fhir:l ; fhir:reference [ fhir:v "Practitioner/ReferralPractitionerExample" ] ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"^^xsd:anyURI ; fhir:l ] ] [ fhir:extension ( [ fhir:url [ fhir:v "productOrServiceCode"^^xsd:anyURI ; fhir:l fhir:productOrServiceCode ] ; fhir:value [ a fhir:CodeableConcept ; fhir:coding ( [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3" ] ; fhir:display [ fhir:v "Consultation" ] ] ) ] ] [ fhir:url [ fhir:v "unitPrice"^^xsd:anyURI ; fhir:l fhir:unitPrice ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:url [ fhir:v "quantity"^^xsd:anyURI ; fhir:l fhir:quantity ] ; fhir:value [ a fhir:Quantity ; fhir:value [ fhir:v "1"^^xsd:decimal ] ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"^^xsd:anyURI ; fhir:l ] ] ) ; fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:adjudication ( [ fhir:extension ( [ fhir:extension ( [ fhir:url [ fhir:v "number"^^xsd:anyURI ; fhir:l fhir:number ] ; fhir:value [ a fhir:String ; fhir:v "AUTH0001" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:CodeableConcept ; fhir:coding ( [ fhir:system [ fhir:v "https://codesystem.x12.org/005010/306"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "A1" ] ; fhir:display [ fhir:v "Certified in total" ] ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"^^xsd:anyURI ; fhir:l ] ] ) ; fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "submitted" ] ] ) ] ] ) ] ) . # a fhir:Us . a fhir:Us . a fhir:Us . a fhir:Us . a fhir:Us . # -------------------------------------------------------------------------------------