a fhir:ExplanationOfBenefit;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "EB3501"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "A human-readable rendering of the ExplanationOfBenefit for a claim that had errors, various other attributes (such as accident and hospitalization) are also completed.
"
];
fhir:ExplanationOfBenefit.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/explanationofbenefit" ];
fhir:Identifier.value [ fhir:value "error-1" ]
];
fhir:ExplanationOfBenefit.status [ fhir:value "active"];
fhir:ExplanationOfBenefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
fhir:Coding.code [ fhir:value "oral" ]
]
];
fhir:ExplanationOfBenefit.subType [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-claimsubtype" ];
fhir:Coding.code [ fhir:value "emergency" ]
]
];
fhir:ExplanationOfBenefit.use [ fhir:value "claim"];
fhir:ExplanationOfBenefit.patient [
fhir:link ;
fhir:Reference.reference [ fhir:value "Patient/pat1" ]
];
fhir:ExplanationOfBenefit.billablePeriod [
fhir:Period.start [ fhir:value "2014-02-01"^^xsd:date ];
fhir:Period.end [ fhir:value "2014-03-01"^^xsd:date ]
];
fhir:ExplanationOfBenefit.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:ExplanationOfBenefit.enterer [
fhir:link ;
fhir:Reference.reference [ fhir:value "Practitioner/1" ]
];
fhir:ExplanationOfBenefit.insurer [
fhir:link ;
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:ExplanationOfBenefit.provider [
fhir:link ;
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:ExplanationOfBenefit.related [
fhir:index 0;
fhir:ExplanationOfBenefit.related.reference [
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/case-number" ];
fhir:Identifier.value [ fhir:value "23-56Tu-XX-47-20150M14" ]
]
];
fhir:ExplanationOfBenefit.prescription [
fhir:link ;
fhir:Reference.reference [ fhir:value "MedicationRequest/medrx002" ]
];
fhir:ExplanationOfBenefit.originalPrescription [
fhir:link ;
fhir:Reference.reference [ fhir:value "MedicationRequest/medrx0301" ]
];
fhir:ExplanationOfBenefit.facility [
fhir:link ;
fhir:Reference.reference [ fhir:value "Location/1" ]
];
fhir:ExplanationOfBenefit.claim [
fhir:link ;
fhir:Reference.reference [ fhir:value "Claim/100150" ]
];
fhir:ExplanationOfBenefit.claimResponse [
fhir:link ;
fhir:Reference.reference [ fhir:value "ClaimResponse/R3500" ]
];
fhir:ExplanationOfBenefit.outcome [ fhir:value "error"];
fhir:ExplanationOfBenefit.disposition [ fhir:value "Could not process."];
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 "employmentimpacted" ]
]
];
fhir:ExplanationOfBenefit.supportingInfo.timingPeriod [
fhir:Period.start [ fhir:value "2014-02-14"^^xsd:date ];
fhir:Period.end [ fhir:value "2014-02-28"^^xsd:date ]
]
], [
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 "hospitalized" ]
]
];
fhir:ExplanationOfBenefit.supportingInfo.timingPeriod [
fhir:Period.start [ fhir:value "2014-02-14"^^xsd:date ];
fhir:Period.end [ fhir:value "2014-02-16"^^xsd:date ]
]
];
fhir:ExplanationOfBenefit.procedure [
fhir:index 0;
fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2014-02-14"^^xsd:date ];
fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ];
fhir:Coding.code [ fhir:value "123001" ]
]
];
fhir:ExplanationOfBenefit.procedure.udi [
fhir:index 0;
fhir:link ;
fhir:Reference.reference [ fhir:value "Device/example" ]
]
];
fhir:ExplanationOfBenefit.precedence [ fhir:value "2"^^xsd:positiveInteger];
fhir:ExplanationOfBenefit.insurance [
fhir:index 0;
fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:ExplanationOfBenefit.insurance.coverage [
fhir:link ;
fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]
]
];
fhir:ExplanationOfBenefit.accident [
fhir:ExplanationOfBenefit.accident.date [ fhir:value "2014-02-14"^^xsd:date ];
fhir:ExplanationOfBenefit.accident.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
fhir:Coding.code [ fhir:value "SPT" ]
]
];
fhir:ExplanationOfBenefit.accident.locationReference [
fhir:link ;
fhir:Reference.reference [ fhir:value "Location/ph" ]
]
];
fhir:ExplanationOfBenefit.total [
fhir:index 0;
fhir:ExplanationOfBenefit.total.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "submitted" ]
]
];
fhir:ExplanationOfBenefit.total.amount [
fhir:Money.value [ fhir:value "2478.57"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 1;
fhir:ExplanationOfBenefit.total.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:ExplanationOfBenefit.total.amount [
fhir:Money.value [ fhir:value "0.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
];
fhir:ExplanationOfBenefit.formCode [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/forms-codes" ];
fhir:Coding.code [ fhir:value "2" ]
]
];
fhir:ExplanationOfBenefit.processNote [
fhir:index 0;
fhir:ExplanationOfBenefit.processNote.number [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.processNote.type [ fhir:value "display" ];
fhir:ExplanationOfBenefit.processNote.text [ fhir:value "Invalid claim" ];
fhir:ExplanationOfBenefit.processNote.language [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "urn:ietf:bcp:47" ];
fhir:Coding.code [ fhir:value "en-CA" ]
]
]
] .
a fhir:Patient .
a fhir:Practitioner .
a fhir:Organization .
a fhir:MedicationRequest .
a fhir:MedicationRequest .
a fhir:Location .
a fhir:Claim .
a fhir:ClaimResponse .
a fhir:Device .
a fhir:Coverage .
a fhir:Location .
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI .
# -------------------------------------------------------------------------------------