LinuxForHealth FHIR Implementation Guide
8.0.0 - draft United States of America flag

LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions

: Coverage Example - Primary Payer - 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:Coverage;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "PrimaryPayerExample"];
  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 "99999" ]     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/ingestion-batch-id" ];
       fhir:Extension.valueString [ fhir:value "b069a545-9506-40c6-8498-23de2e189143" ]     ];
     fhir:Meta.source [ fhir:value "http://acme-health.com/emr1" ];
     fhir:Meta.profile [
       fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-coverage";
       fhir:index 0;
       fhir:link <http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-coverage>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"PrimaryPayerExample\"> </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 Coverage \"PrimaryPayerExample\" </p><p style=\"margin-bottom: 0px\">Information Source: http://acme-health.com/emr1!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdm-coverage.html\">CDM Coverage</a></p></div><p><b>identifier</b>: Source System Row Identifier: c35466d6-0d2b-4efa-8265-b9ac3f887e08(use: OFFICIAL)</p><p><b>status</b>: active</p><p><b>type</b>: preferred provider organization policy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-v3-ActCode.html\">ActCode</a>#PPO)</span></p><p><b>policyHolder</b>: <a href=\"Organization-Employer1.html\">Organization/Employer1</a> \"Employer 1\"</p><p><b>subscriber</b>: <span></span></p><p><b>beneficiary</b>: <a href=\"Patient-CDMPatientInstance.html\">Patient/CDMPatientInstance</a> \" MCLASTNAME\"</p><p><b>relationship</b>: Spouse <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#spouse)</span></p><p><b>period</b>: 2020-01-01 12:00:00+0000 --&gt; (ongoing)</p><p><b>payor</b>: <a href=\"Organization-Payer1.html\">Organization/Payer1</a> \"Payer 1\"</p><blockquote><p><b>class</b></p><p><b>type</b>: Group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#group)</span></p><p><b>value</b>: 10985-PAYER1</p><p><b>name</b>: PPO with HSA</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Plan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#plan)</span></p><p><b>value</b>: 282</p></blockquote><p><b>order</b>: 1</p><p><b>network</b>: Choice POS II</p></div>"
  ];
  fhir:Coverage.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/emr1/coverage" ];
     fhir:Identifier.value [ fhir:value "c35466d6-0d2b-4efa-8265-b9ac3f887e08" ];
     fhir:Identifier.assigner [
       fhir:Reference.display [ fhir:value "Acme Health - EMR1" ]     ]
  ];
  fhir:Coverage.status [ fhir:value "active"];
  fhir:Coverage.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
       fhir:Coding.code [ fhir:value "PPO" ]     ]
  ];
  fhir:Coverage.policyHolder [
     fhir:Reference.reference [ fhir:value "Organization/Employer1" ]
  ];
  fhir:Coverage.subscriber [
     fhir:Reference.type [ fhir:value "RelatedPerson" ];
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "http://acme-health.com/emr1/related-person" ];
       fhir:Identifier.value [ fhir:value "Spouse1" ]     ]
  ];
  fhir:Coverage.beneficiary [
     fhir:Reference.reference [ fhir:value "Patient/CDMPatientInstance" ]
  ];
  fhir:Coverage.relationship [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/subscriber-relationship" ];
       fhir:Coding.code [ fhir:value "spouse" ]     ]
  ];
  fhir:Coverage.period [
     fhir:Period.start [ fhir:value "2020-01-01T00:00:00Z"^^xsd:dateTime ]
  ];
  fhir:Coverage.payor [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "Organization/Payer1" ]
  ];
  fhir:Coverage.class [
     fhir:index 0;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "group" ]       ]     ];
     fhir:Coverage.class.value [ fhir:value "10985-PAYER1" ];
     fhir:Coverage.class.name [ fhir:value "PPO with HSA" ]
  ], [
     fhir:index 1;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "plan" ]       ]     ];
     fhir:Coverage.class.value [ fhir:value "282" ]
  ];
  fhir:Coverage.order [ fhir:value "1"^^xsd:positiveInteger];
  fhir:Coverage.network [ fhir:value "Choice POS II"].

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

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