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:ExplanationOfBenefit;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "CDMExplanationOfBenefitForAnalyticsDrugInstance"];
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 "rgVCJnQBxvghkKTI8Hzzx2" ] ], [
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_x2" ] ] ];
fhir:Meta.source [ fhir:value "http://acme-health.com/WellnessCenterPharmacy" ];
fhir:Meta.profile [
fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-explanation-of-benefit-for-analytics";
fhir:index 0;
fhir:link <http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-explanation-of-benefit-for-analytics> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name=\"CDMExplanationOfBenefitForAnalyticsDrugInstance\"> </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 ExplanationOfBenefit \"CDMExplanationOfBenefitForAnalyticsDrugInstance\" </p><p style=\"margin-bottom: 0px\">Information Source: http://acme-health.com/WellnessCenterPharmacy!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdm-explanation-of-benefit-for-analytics.html\">CDM Explanation of Benefit for Analytics</a></p></div><p><b>Snapshot Age In Years</b>: 27</p><p><b>identifier</b>: Source System Row Identifier: 000000000000000000019721078x2(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>provider</b>: <a href=\"Practitioner-DrKelly.html\">Practitioner/DrKelly</a> \" KELLY\"</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><p><b>outcome</b>: complete</p><h3>CareTeams</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td></tr><tr><td>*</td><td>1</td><td><a href=\"Practitioner-DrKelly.html\">Practitioner/DrKelly</a> \" KELLY\"</td><td>Ordering provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-care-team-role.html\">Claim Care Team Role Codes</a>#ordering)</span></td></tr></table><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: Day Supply <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-category.html\">Claim Supporting Info Category Codes</a>#dayssupply)</span></p><p><b>value</b>: 28</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: Information <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: 0 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ncpdp-dispense-as-written.html\">NCPDP Dispense As Written Codes</a>#0)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: Information <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: Refill number <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#refill-number)</span></p><p><b>value</b>: 1</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 4</p><p><b>category</b>: Information <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claiminformationcategory.html\">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: Retail <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-rx-mail-or-retail.html\">Rx Mail Or Retail Codes</a>#r)</span></p></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><a href=\"Coverage-PrimaryPayerExample.html\">Coverage/PrimaryPayerExample</a></td></tr></table><blockquote><p><b>item</b></p><p><b>Capitated Service Indicator</b>: N</p><p><b>Average Wholesale Price</b>: <span title=\"US Dollar\">US$2.88</span> (USD)</p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: 69452-0151-20 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndc-no-hyphens.html\">NDC No Hyphens Codes</a>#69452015120)</span></p><p><b>serviced</b>: 2017-06-18</p><p><b>location</b>: Pharmacy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-CMSPlaceofServiceCodes.html\">CMS Place of Service Codes (POS)</a>#01; local-place-of-service#LocalPlcOfService)</span></p><p><b>quantity</b>: 4 metric</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>0.48</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>0</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>: 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>1.59</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><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>1.11</td><td>USD</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>Claim Item Detail Classification</b>: Dispensing Fee <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-item-detail-classification.html\">Claim Item Detail Classification Codes</a>#dispensing-fee)</span></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: 69452-0151-20 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndc-no-hyphens.html\">NDC No Hyphens Codes</a>#69452015120)</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>0.45</td><td>USD</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>Claim Item Detail Classification</b>: Ingredient Cost <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-item-detail-classification.html\">Claim Item Detail Classification Codes</a>#ingredient-cost)</span></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: 69452-0151-20 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndc-no-hyphens.html\">NDC No Hyphens Codes</a>#69452015120)</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>1.14</td><td>USD</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>Claim Item Detail Classification</b>: Sales Tax <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-item-detail-classification.html\">Claim Item Detail Classification Codes</a>#sales-tax)</span></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: 69452-0151-20 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndc-no-hyphens.html\">NDC No Hyphens Codes</a>#69452015120)</span></p><h3>UnitPrices</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><h3>Adjudications</h3><table class=\"grid\"><tr><td>-</td><td><b>Category</b></td></tr><tr><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></div>"
];
fhir:DomainResource.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-years" ];
fhir:Extension.valueUnsignedInt [ fhir:value "27"^^xsd:nonNegativeInteger ]
];
fhir:ExplanationOfBenefit.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-eob-identifier" ];
fhir:Identifier.value [ fhir:value "000000000000000000019721078x2" ];
fhir:Identifier.assigner [
fhir:Reference.display [ fhir:value "Acme Health - Wellness Center Pharmacy" ] ]
];
fhir:ExplanationOfBenefit.status [ fhir:value "active"];
fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.use [ fhir:value "claim"];
fhir:ExplanationOfBenefit.patient [
fhir:Reference.reference [ fhir:value "Patient/CDMPatientInstance" ]
];
fhir:ExplanationOfBenefit.created [ fhir:value "2017-07-25T17:31:00-05:00"^^xsd:dateTime];
fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.provider [
fhir:Reference.reference [ fhir:value "Practitioner/DrKelly" ]
];
fhir:ExplanationOfBenefit.priority [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
fhir:Coding.code [ fhir:value "normal" ] ]
];
fhir:ExplanationOfBenefit.outcome [ fhir:value "complete"];
fhir:ExplanationOfBenefit.careTeam [
fhir:index 0;
fhir:ExplanationOfBenefit.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.careTeam.provider [
fhir:Reference.reference [ fhir:value "Practitioner/DrKelly" ] ];
fhir:ExplanationOfBenefit.careTeam.role [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-care-team-role" ];
fhir:Coding.code [ fhir:value "ordering" ] ] ]
];
fhir:ExplanationOfBenefit.supportingInfo [
fhir:index 0;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-category" ];
fhir:Coding.code [ fhir:value "dayssupply" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.valueQuantity [
fhir:Quantity.value [ fhir:value "28"^^xsd:decimal ] ]
], [
fhir:index 1;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "info" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/ncpdp-dispense-as-written" ];
fhir:Coding.code [ fhir:value "0" ];
fhir:Coding.display [ fhir:value "0" ] ] ]
], [
fhir:index 2;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "info" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-supporting-info-type" ];
fhir:Coding.code [ fhir:value "refill-number" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.valueQuantity [
fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ] ]
], [
fhir:index 3;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "4"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "info" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/rx-mail-or-retail" ];
fhir:Coding.code [ fhir:value "r" ] ] ]
];
fhir:ExplanationOfBenefit.insurance [
fhir:index 0;
fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:ExplanationOfBenefit.insurance.coverage [
fhir:Reference.reference [ fhir:value "Coverage/PrimaryPayerExample" ] ]
];
fhir:ExplanationOfBenefit.item [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/capitated-service-indicator" ];
fhir:Extension.valueString [ fhir:value "N" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/average-wholesale-price" ];
fhir:Extension.valueMoney [
fhir:Money.value [ fhir:value "2.88"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ];
fhir:ExplanationOfBenefit.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.item.careTeamSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0 ];
fhir:ExplanationOfBenefit.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/ndc-no-hyphens" ];
fhir:Coding.code [ fhir:value "69452015120" ] ] ];
fhir:ExplanationOfBenefit.item.servicedDate [ fhir:value "2017-06-18"^^xsd:date ];
fhir:ExplanationOfBenefit.item.locationCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set" ];
fhir:Coding.code [ fhir:value "01" ];
fhir:Coding.display [ fhir:value "Pharmacy" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-place-of-service" ];
fhir:Coding.code [ fhir:value "LocalPlcOfService" ] ] ];
fhir:ExplanationOfBenefit.item.quantity [
fhir:Quantity.value [ fhir:value "4"^^xsd:decimal ];
fhir:Quantity.unit [ fhir:value "metric" ] ];
fhir:ExplanationOfBenefit.item.adjudication [
fhir:index 0;
fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "0.48"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 1;
fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 2;
fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 3;
fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 4;
fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "1.59"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 5;
fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "1.11"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ];
fhir:ExplanationOfBenefit.item.detail [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-item-detail-classification" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-item-detail-classification" ];
fhir:Coding.code [ fhir:value "dispensing-fee" ] ] ] ];
fhir:ExplanationOfBenefit.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.item.detail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/ndc-no-hyphens" ];
fhir:Coding.code [ fhir:value "69452015120" ] ] ];
fhir:ExplanationOfBenefit.item.detail.unitPrice [
fhir:Money.value [ fhir:value "0.45"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 1;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-item-detail-classification" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-item-detail-classification" ];
fhir:Coding.code [ fhir:value "ingredient-cost" ] ] ] ];
fhir:ExplanationOfBenefit.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.item.detail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/ndc-no-hyphens" ];
fhir:Coding.code [ fhir:value "69452015120" ] ] ];
fhir:ExplanationOfBenefit.item.detail.unitPrice [
fhir:Money.value [ fhir:value "1.14"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ], [
fhir:index 2;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-item-detail-classification" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/claim-item-detail-classification" ];
fhir:Coding.code [ fhir:value "sales-tax" ] ] ] ];
fhir:ExplanationOfBenefit.item.detail.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.item.detail.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://linuxforhealth.org/fhir/cdm/CodeSystem/ndc-no-hyphens" ];
fhir:Coding.code [ fhir:value "69452015120" ] ] ];
fhir:ExplanationOfBenefit.item.detail.unitPrice [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ] ]
];
fhir:ExplanationOfBenefit.adjudication [
fhir:index 0;
fhir:ExplanationOfBenefit.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" ] ] ]
].
# - 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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