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

: CDM Explanation of Benefit - Professional Example - TTL Representation

Raw ttl | Download


@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 "CDMExplanationOfBenefitProfessionalInstance"];
  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_e00080779_3938586_2516181" ]       ]     ];
     fhir:Meta.source [ fhir:value "http://acme-health.com/WellnessMedicalCenter" ];
     fhir:Meta.profile [
       fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-explanation-of-benefit";
       fhir:index 0;
       fhir:link <http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-explanation-of-benefit>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name=\"CDMExplanationOfBenefitProfessionalInstance\"> </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 \"CDMExplanationOfBenefitProfessionalInstance\" </p><p style=\"margin-bottom: 0px\">Information Source: http://acme-health.com/WellnessMedicalCenter!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdm-explanation-of-benefit.html\">CDM Explanation of Benefit</a></p></div><p><b>identifier</b>: Source System Row Identifier: 000000000000000000019721078(use: OFFICIAL)</p><p><b>status</b>: active</p><p><b>type</b>: MedicalClaimType <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (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>provider</b>: <a href=\"Practitioner-DrKelly.html\">Practitioner/DrKelly</a> \" KELLY\"</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>Servicing 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>#servicing)</span></td></tr></table><h3>SupportingInfos</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>1</td><td>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></td><td>Network provider indicator <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-claim-supporting-info-type.html\">Claim Supporting Info Type Codes</a>#network-provider-indicator)</span></td><td>Y</td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td>*</td><td>1</td><td>Encntr for general adult medical exam w/o abnormal findings <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#Z00.00)</span></td><td>Discharge Diagnosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-ex-diagnosistype.html\">Example Diagnosis Type Codes</a>#discharge)</span></td></tr></table><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>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (2.16.840.1.113883.6.285#G0438)</span></p><p><b>serviced</b>: 2017-06-20 --&gt; 2017-06-20</p><p><b>location</b>: Office <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>#11; local-place-of-service#LocalPlcOfService)</span></p><p><b>quantity</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>: 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><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><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><blockquote><p><b>payment</b></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>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>100</td></tr></table></blockquote></div>"
  ];
  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 "000000000000000000019721078" ];
     fhir:Identifier.assigner [
       fhir:Reference.display [ fhir:value "Acme Health - Wellness Medical Center" ]     ]
  ];
  fhir:ExplanationOfBenefit.status [ fhir:value "active"];
  fhir:ExplanationOfBenefit.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://acme-health.com/CodeSystem/local-claim-type" ];
       fhir:Coding.code [ fhir:value "MedicalClaimType" ]     ]
  ];
  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.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 "servicing" ]       ]     ]
  ];
  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://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 "network-provider-indicator" ]       ]     ];
     fhir:ExplanationOfBenefit.supportingInfo.valueString [ fhir:value "Y" ]
  ];
  fhir:ExplanationOfBenefit.diagnosis [
     fhir:index 0;
     fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
         fhir:Coding.code [ fhir:value "Z00.00" ];
         fhir:Coding.display [ fhir:value "Encntr for general adult medical exam w/o abnormal findings" ]       ]     ];
     fhir:ExplanationOfBenefit.diagnosis.type [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ];
         fhir:Coding.code [ fhir:value "discharge" ]       ]     ]
  ];
  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: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 "https://oidref.com/2.16.840.1.113883.6.285" ];
         fhir:Coding.code [ fhir:value "G0438" ]       ];
       fhir:CodeableConcept.text [ fhir:value "Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit" ]     ];
     fhir:ExplanationOfBenefit.item.servicedPeriod [
       fhir:Period.start [ fhir:value "2017-06-20"^^xsd:date ];
       fhir:Period.end [ fhir:value "2017-06-20"^^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 "11" ];
         fhir:Coding.display [ fhir:value "Office" ]       ], [
         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:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "http://linuxforhealth.org/fhir/cdm/StructureDefinition/local-number-of-units-per-service" ];
         fhir:Extension.valueQuantity [
           fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ]         ]       ];
       fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ]     ];
     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"^^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 "25"^^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 "125"^^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 "submitted" ]         ]       ];
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "165"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ]     ], [
       fhir:index 6;
       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 "100"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ]     ], [
       fhir:index 7;
       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 "discount" ]         ]       ];
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "40"^^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" ]       ]     ]
  ];
  fhir:ExplanationOfBenefit.payment [
     fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.payment.date [ fhir:value "2017-07-20"^^xsd:date ];
     fhir:ExplanationOfBenefit.payment.amount [
       fhir:Money.value [ fhir:value "100"^^xsd:decimal ]     ]
  ].

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

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