LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions
@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 "CDMClaimResponseDrugInstance"];
fhir:Resource.meta [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/tenant-id" ];
fhir:Extension.valueString [ fhir:value "tenant7209" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/ingestion-batch-id" ];
fhir:Extension.valueString [ fhir:value "rgVCJnQBxvghkKTI8Hzz" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/process-name" ];
fhir:Extension.valueString [ fhir:value "TREX" ] ], [
fhir:index 3;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/process-client-id" ];
fhir:Extension.valueString [ fhir:value "7209" ] ], [
fhir:index 4;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/process-record-id" ];
fhir:Extension.valueIdentifier [
fhir:Identifier.system [ fhir:value "http://acme-health.com/WellnessCenterPharmacy" ];
fhir:Identifier.value [ fhir:value "7209_07869_e00080779_3938586_2516181" ] ] ], [
fhir:index 5;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/source-file-id" ];
fhir:Extension.valueString [ fhir:value "e00080779" ] ];
fhir:Meta.source [ fhir:value "http://acme-health.com/WellnessCenterPharmacy" ];
fhir:Meta.profile [
fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-claim-response-drug";
fhir:index 0;
fhir:link <http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-claim-response-drug> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"CDMClaimResponseDrugInstance\"> </a></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 \"CDMClaimResponseDrugInstance\" </p><p style=\"margin-bottom: 0px\">Information Source: http://acme-health.com/WellnessCenterPharmacy!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdm-claim-response-drug.html\">CDM Claim Response Drug</a></p></div><p><b>Claim Status</b>: LocClaimSts <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-claim-status#LocClaimSts)</span></p><p><b>Claim Received Date</b>: 2017-06-01</p><p><b>identifier</b>: Prescription Number: 000000000000000000019721078(use: OFFICIAL)</p><p><b>status</b>: active</p><p><b>type</b>: Pharmacy; Pharmacy claims for goods and services <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-claim-type.html\">Payer Claim Type Codes</a>#pharmacy; local-claim-type#Pharmacy)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-CDMPatientInstance.html\">Patient/CDMPatientInstance</a> \" MCLASTNAME\"</p><p><b>created</b>: 2017-07-25 05:31:00-0500</p><p><b>insurer</b>: <span></span></p><p><b>outcome</b>: complete</p><blockquote><p><b>item</b></p><p><b>Claim Response Item Status</b>: Paid <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-claim-status.html\">Payer Claim Status Codes</a>#P)</span></p><p><b>Claim Response Benefit Plan</b>: <a href=\"Coverage-CoverageDrugExample.html\">Coverage/CoverageDrugExample</a></p><p><b>Rx Formulary Indicator</b>: N</p><p><b>Rx Pay Tier</b>: Tier1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-rx-pay-tier#Tier1)</span></p><p><b>Rx Supply Indicator</b>: N</p><p><b>Usual And Customary Amount</b>: 0</p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: Coinsurance <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#coinsurance)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>18.86</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Copayment <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#copay)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>10</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Deductible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#deductible)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>10</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Tax Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#tax)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>1.01</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Third Party Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#third-party)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Allowed Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#allowed)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>25</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Submitted <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>5</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Net Payment <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#net-payment)</span></p><p><b>reason</b>: M50 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-RARC.html\">X12 Remittance Advice Remark Codes</a>#M50; <a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-RARC.html\">X12 Remittance Advice Remark Codes</a>#N423)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Discount Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#discount)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Fee For Service Equivalent <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#ffs-equivalent)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Fully Insured Payment <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#fully-insured-payment)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Healthcare Reimbursement Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#healthcare-reimbursement)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Healthcare Savings Account <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#healthcare-savings-account)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Medicare Allowed Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#medicare-allowed)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Medicare Coinsurance Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#medicare-coinsurance)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Medicare Deductible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#medicare-deductible)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Patient Liability <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#patient-liability)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Penalty <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#penalty)</span></p><p><b>reason</b>: LocPenaltyType <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-penalty-type#LocPenaltyType)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>1</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Excess Copayment <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#excess_copay)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Medicare Paid Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#medicare-paid)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>0</td></tr></table></blockquote></blockquote><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>In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-paid-in-network-indicator.html\">Paid In Network Indicator Codes</a>#in-network)</span></td></tr></table><blockquote><p><b>payment</b></p><p><b>Claim Adjustment Type</b>: Adjustment (positive or negative adjustment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-claim-adjustment-type.html\">Payer Claim Adjustment Type Codes</a>#1)</span></p><p><b>Claim Adjustment Type</b>: LocalClaimAdjType <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-claim-adjustment-type#LocalClaimAdjType)</span></p><p><b>Disposition Reason</b>: record-in-error-correct-and-resubmit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-disposition-reason#record-in-error-correct-and-resubmit)</span></p><p><b>type</b>: Complete <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-ex-paymenttype.html\">Example Payment Type Codes</a>#complete)</span></p><p><b>adjustmentReason</b>: local-adj-reason <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-adjustment-reason#local-adj-reason)</span></p><p><b>date</b>: 2017-07-20</p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td></tr><tr><td>*</td><td>5</td></tr></table></blockquote></div>"
];
fhir:DomainResource.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-claim-status" ];
fhir:Coding.code [ fhir:value "LocClaimSts" ] ] ]
], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-received-date" ];
fhir:Extension.valueDate [ fhir:value "2017-06-01"^^xsd:date ]
];
fhir:ClaimResponse.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "official" ];
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/identifier-type" ];
fhir:Coding.code [ fhir:value "RXN" ] ] ];
fhir:Identifier.system [ fhir:value "http://acme-health.com/CodeSystem/local-claim-identifier" ];
fhir:Identifier.value [ fhir:value "000000000000000000019721078" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Acme Health - Wellness Center Pharmacy" ] ]
];
fhir:ClaimResponse.status [ fhir:value "active"];
fhir:ClaimResponse.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-type" ];
fhir:Coding.code [ fhir:value "pharmacy" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-claim-type" ];
fhir:Coding.code [ fhir:value "Pharmacy" ] ]
];
fhir:ClaimResponse.use [ fhir:value "claim"];
fhir:ClaimResponse.patient [
fhir:Reference.reference [ fhir:value "Patient/CDMPatientInstance" ]
];
fhir:ClaimResponse.created [ fhir:value "2017-07-25T17:31:00-05:00"^^xsd:dateTime];
fhir:ClaimResponse.insurer [
fhir:Reference.type [ fhir:value "Organization" ];
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://acme-health.com/payer1/payer" ];
fhir:Identifier.value [ fhir:value "Payer1" ] ]
];
fhir:ClaimResponse.outcome [ fhir:value "complete"];
fhir:ClaimResponse.item [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-item-status" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-status" ];
fhir:Coding.code [ fhir:value "P" ];
fhir:Coding.display [ fhir:value "Paid" ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-benefit-plan" ];
fhir:Extension.valueReference [
fhir:Reference.reference [ fhir:value "Coverage/CoverageDrugExample" ] ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/rx-formulary-indicator" ];
fhir:Extension.valueString [ fhir:value "N" ] ], [
fhir:index 3;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/rx-pay-tier" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-rx-pay-tier" ];
fhir:Coding.code [ fhir:value "Tier1" ] ] ] ], [
fhir:index 4;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/rx-supply-indicator" ];
fhir:Extension.valueString [ fhir:value "N" ] ], [
fhir:index 5;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/usual-and-customary-amount" ];
fhir:Extension.valueDecimal [ fhir:value "0"^^xsd:decimal ] ];
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://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "coinsurance" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "18.86"^^xsd:decimal ] ] ], [
fhir:index 1;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "copay" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "10"^^xsd:decimal ] ] ], [
fhir:index 2;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "deductible" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "10"^^xsd:decimal ] ] ], [
fhir:index 3;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "tax" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "1.01"^^xsd:decimal ] ] ], [
fhir:index 4;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "third-party" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 5;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "allowed" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "25"^^xsd:decimal ] ] ], [
fhir:index 6;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "submitted" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "5"^^xsd:decimal ] ] ], [
fhir:index 7;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "net-payment" ] ] ];
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://x12.org/codes/remittance-advice-remark-codes" ];
fhir:Coding.code [ fhir:value "M50" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "https://x12.org/codes/remittance-advice-remark-codes" ];
fhir:Coding.code [ fhir:value "N423" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 8;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "discount" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 9;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "ffs-equivalent" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 10;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "fully-insured-payment" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 11;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "healthcare-reimbursement" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 12;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "healthcare-savings-account" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 13;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "medicare-allowed" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 14;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "medicare-coinsurance" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 15;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "medicare-deductible" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 16;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "patient-liability" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 17;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "penalty" ] ] ];
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-penalty-type" ];
fhir:Coding.code [ fhir:value "LocPenaltyType" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "1"^^xsd:decimal ] ] ], [
fhir:index 18;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "excess_copay" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [
fhir:index 19;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/adjudication-category" ];
fhir:Coding.code [ fhir:value "medicare-paid" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ]
];
fhir:ClaimResponse.adjudication [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date" ];
fhir:Extension.valueDate [ fhir:value "2017-06-30"^^xsd:date ] ];
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/paid-in-network-indicator" ];
fhir:Coding.code [ fhir:value "in-network" ] ] ]
];
fhir:ClaimResponse.payment [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-adjustment-type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type" ];
fhir:Coding.code [ fhir:value "1" ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-adjustment-type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-claim-adjustment-type" ];
fhir:Coding.code [ fhir:value "LocalClaimAdjType" ] ] ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/disposition-reason" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-disposition-reason" ];
fhir:Coding.code [ fhir:value "record-in-error-correct-and-resubmit" ] ] ] ];
fhir:ClaimResponse.payment.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-paymenttype" ];
fhir:Coding.code [ fhir:value "complete" ] ] ];
fhir:ClaimResponse.payment.adjustmentReason [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-adjustment-reason" ];
fhir:Coding.code [ fhir:value "local-adj-reason" ] ] ];
fhir:ClaimResponse.payment.date [ fhir:value "2017-07-20"^^xsd:date ];
fhir:ClaimResponse.payment.amount [
fhir:Money.value [ fhir:value "5"^^xsd:decimal ] ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ LinuxForHealth Team. Package linuxforhealth.fhir.ig#8.0.0 based on FHIR 4.0.1. Generated 2022-11-10
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