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 "CDMClaimResponseFacilityInstance"];
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/WellnessMedicalCenter" ];
fhir:Identifier.value [ fhir:value "7209_07869_e00080722_3938586_2516181" ] ] ], [
fhir:index 5;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/source-file-id" ];
fhir:Extension.valueString [ fhir:value "e00080722" ] ];
fhir:Meta.source [ fhir:value "http://acme-health.com/WellnessMedicalCenter" ];
fhir:Meta.profile [
fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-claim-response";
fhir:index 0;
fhir:link <http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-claim-response> ]
];
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=\"CDMClaimResponseFacilityInstance\"> </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 \"CDMClaimResponseFacilityInstance\" </p><p style=\"margin-bottom: 0px\">Information Source: http://acme-health.com/WellnessMedicalCenter!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdm-claim-response.html\">CDM Claim Response</a></p></div><p><b>Claim Received Date</b>: 2017-06-01</p><p><b>Claim Status</b>: LocClaimStatus <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-claim-status#LocClaimStatus)</span></p><p><b>Days To Process</b>: 15</p><p><b>identifier</b>: Source System Row Identifier: 000000000000000000019721078(use: OFFICIAL)</p><p><b>status</b>: active</p><p><b>type</b>: Medical claim; Institutional/Professional unknown <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-claim-type.html\">Payer Claim Type Codes</a>#medical; local-claim-type#MedicalClaimType)</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>Copay Exclusion</b>: LocCopayExclusion <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-copay-exclusion#LocCopayExclusion)</span></p><p><b>Number of Units Allowed</b>: 2</p><p><b>Reinsurance Met Indicator</b>: Y</p><p><b>Utilization Review</b>: LocUtilizatinoReviewCd <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-utilization-review#LocUtilizatinoReviewCd)</span></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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>25</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>1</td><td>USD</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>Savings Type</b>: LocalSavingsType <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-savings-type#LocalSavingsType)</span></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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>125</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>165</td><td>USD</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>: M2 <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>#M2; <a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-RARC.html\">X12 Remittance Advice Remark Codes</a>#N16; local-explanation-of-benefits#LocalEOB; local-denied-reason#LocalDeniedReason)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>100</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>40</td><td>USD</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><p><b>reason</b>: LocalDiscountType <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-discount-type#LocalDiscountType)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</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></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><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Risk Withhold <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#withhold)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Excluded Amount 1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#excluded1)</span></p><p><b>reason</b>: LocalExcludedReason1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-excluded-reason_1#LocalExcludedReason1)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Excluded Amount 2 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#excluded2)</span></p><p><b>reason</b>: LocalExcludedReason2 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-excluded-reason_2#LocalExcludedReason2)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Excluded Reason <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#excluded-reason)</span></p><p><b>reason</b>: LocalExcludedReason3 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-excluded-reason_3#LocalExcludedReason3)</span></p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: DRG Outlier <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#drg-outlier)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>Routing Number Code</b>: 12345</p><p><b>category</b>: ITS Access Fee (Out of Network Access Fee) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#out-of-network-access-fee)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: ITS Surcharge Amount (Out of Network Surcharge Amount) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#out-of-network-surcharge-fee)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>0</td><td>USD</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Summary <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-adjudication-category.html\">Adjudication Category Codes</a>#summary)</span></p><p><b>reason</b>: LocalEOB1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-explanation-of-benefits#LocalEOB1; local-explanation-of-benefits#LocalEOB2)</span></p></blockquote></blockquote><h3>Adjudications</h3><table class=\"grid\"><tr><td>-</td><td><b>Extension</b></td><td><b>Category</b></td><td><b>Reason</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><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>Reimburse Type</b>: LocalReimburseType <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-reimburse-type#LocalReimburseType)</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><blockquote><p><b>error</b></p><p><b>code</b>: LocErrorDetail1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-error-detail#LocErrorDetail1)</span></p></blockquote><blockquote><p><b>error</b></p><p><b>code</b>: LocErrorDetail2 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-error-header#LocErrorDetail2)</span></p></blockquote><blockquote><p><b>error</b></p><p><b>code</b>: LocErrorDetail3 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-error-detail#LocErrorDetail3)</span></p></blockquote><blockquote><p><b>error</b></p><p><b>code</b>: LocErrorDetail4 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-error-detail#LocErrorDetail4)</span></p></blockquote><blockquote><p><b>error</b></p><p><b>code</b>: LocErrorHeader1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-error-header#LocErrorHeader1)</span></p></blockquote><blockquote><p><b>error</b></p><p><b>code</b>: LocExceptionDetail1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-exception-detail#LocExceptionDetail1)</span></p></blockquote><blockquote><p><b>error</b></p><p><b>code</b>: LocExceptionDetail2 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-exception-detail#LocExceptionDetail2)</span></p></blockquote><blockquote><p><b>error</b></p><p><b>code</b>: LocExceptionHeader1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-exception-header#LocExceptionHeader1)</span></p></blockquote><blockquote><p><b>error</b></p><p><b>code</b>: LocExceptionHeader2 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-exception-header#LocExceptionHeader2)</span></p></blockquote></div>"
];
fhir:DomainResource.extension [
fhir:index 0;
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:index 1;
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 "LocClaimStatus" ] ] ]
], [
fhir:index 2;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/days-to-process" ];
fhir:Extension.valueInteger [ fhir:value "15"^^xsd:integer ]
];
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 "SSRI" ] ] ];
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 Medical Center" ] ]
];
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 "medical" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-claim-type" ];
fhir:Coding.code [ fhir:value "MedicalClaimType" ] ]
];
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/copay-exclusion" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-copay-exclusion" ];
fhir:Coding.code [ fhir:value "LocCopayExclusion" ] ] ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/number-of-units-allowed" ];
fhir:Extension.valueInteger [ fhir:value "2"^^xsd:integer ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/reinsurance-met-indicator" ];
fhir:Extension.valueString [ fhir:value "Y" ] ], [
fhir:index 3;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/utilization-review" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-utilization-review" ];
fhir:Coding.code [ fhir:value "LocUtilizatinoReviewCd" ] ] ] ];
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 "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "25"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 4;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/savings-type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-savings-type" ];
fhir:Coding.code [ fhir:value "LocalSavingsType" ] ] ] ];
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:Money.currency [ fhir:value "USD" ] ] ], [
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 "125"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "165"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "M2" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "https://x12.org/codes/remittance-advice-remark-codes" ];
fhir:Coding.code [ fhir:value "N16" ] ], [
fhir:index 2;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-explanation-of-benefits" ];
fhir:Coding.code [ fhir:value "LocalEOB" ] ], [
fhir:index 3;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-denied-reason" ];
fhir:Coding.code [ fhir:value "LocalDeniedReason" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "100"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "40"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "discount" ] ] ];
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-discount-type" ];
fhir:Coding.code [ fhir:value "LocalDiscountType" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "ffs-equivalent" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "fully-insured-payment" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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-reimbursement" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "healthcare-savings-account" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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-allowed" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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-coinsurance" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "medicare-deductible" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "patient-liability" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
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 "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: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:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 20;
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 "withhold" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 21;
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 "excluded1" ] ] ];
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-excluded-reason_1" ];
fhir:Coding.code [ fhir:value "LocalExcludedReason1" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 22;
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 "excluded2" ] ] ];
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-excluded-reason_2" ];
fhir:Coding.code [ fhir:value "LocalExcludedReason2" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 23;
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 "excluded-reason" ] ] ];
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-excluded-reason_3" ];
fhir:Coding.code [ fhir:value "LocalExcludedReason3" ] ] ] ], [
fhir:index 24;
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 "drg-outlier" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 25;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/routing-number-code" ];
fhir:Extension.valueString [ fhir:value "12345" ] ];
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 "out-of-network-access-fee" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 26;
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 "out-of-network-surcharge-fee" ] ] ];
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 27;
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 "summary" ] ] ];
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-explanation-of-benefits" ];
fhir:Coding.code [ fhir:value "LocalEOB1" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-explanation-of-benefits" ];
fhir:Coding.code [ fhir:value "LocalEOB2" ] ] ] ]
];
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.item.adjudication.reason [
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:index 3;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/reimburse-type" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-reimburse-type" ];
fhir:Coding.code [ fhir:value "LocalReimburseType" ] ] ] ];
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 ] ]
];
fhir:ClaimResponse.error [
fhir:index 0;
fhir:ClaimResponse.error.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-error-detail" ];
fhir:Coding.code [ fhir:value "LocErrorDetail1" ] ] ]
], [
fhir:index 1;
fhir:ClaimResponse.error.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-error-header" ];
fhir:Coding.code [ fhir:value "LocErrorDetail2" ] ] ]
], [
fhir:index 2;
fhir:ClaimResponse.error.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-error-detail" ];
fhir:Coding.code [ fhir:value "LocErrorDetail3" ] ] ]
], [
fhir:index 3;
fhir:ClaimResponse.error.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-error-detail" ];
fhir:Coding.code [ fhir:value "LocErrorDetail4" ] ] ]
], [
fhir:index 4;
fhir:ClaimResponse.error.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-error-header" ];
fhir:Coding.code [ fhir:value "LocErrorHeader1" ] ] ]
], [
fhir:index 5;
fhir:ClaimResponse.error.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-exception-detail" ];
fhir:Coding.code [ fhir:value "LocExceptionDetail1" ] ] ]
], [
fhir:index 6;
fhir:ClaimResponse.error.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-exception-detail" ];
fhir:Coding.code [ fhir:value "LocExceptionDetail2" ] ] ]
], [
fhir:index 7;
fhir:ClaimResponse.error.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-exception-header" ];
fhir:Coding.code [ fhir:value "LocExceptionHeader1" ] ] ]
], [
fhir:index 8;
fhir:ClaimResponse.error.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-exception-header" ];
fhir:Coding.code [ fhir:value "LocExceptionHeader2" ] ] ]
].
# - 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
Links: Table of Contents |
QA Report