a fhir:PaymentReconciliation;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "ER2500"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "A human-readable rendering of the PaymentReconciliation
"
];
fhir:PaymentReconciliation.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/enrollmentresponse" ];
fhir:Identifier.value [ fhir:value "781234" ]
];
fhir:PaymentReconciliation.status [ fhir:value "active"];
fhir:PaymentReconciliation.period [
fhir:Period.start [ fhir:value "2014-08-16"^^xsd:date ];
fhir:Period.end [ fhir:value "2014-08-31"^^xsd:date ]
];
fhir:PaymentReconciliation.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:PaymentReconciliation.paymentIssuer [
fhir:link ;
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:PaymentReconciliation.request [
fhir:link ;
fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/eligibility/225476332402" ]
];
fhir:PaymentReconciliation.requestor [
fhir:link ;
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:PaymentReconciliation.outcome [ fhir:value "complete"];
fhir:PaymentReconciliation.disposition [ fhir:value "2014 August mid-month settlement."];
fhir:PaymentReconciliation.paymentDate [ fhir:value "2014-08-01"^^xsd:date];
fhir:PaymentReconciliation.paymentAmount [
fhir:Money.value [ fhir:value "7000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:PaymentReconciliation.paymentIdentifier [
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/payment/2018" ];
fhir:Identifier.value [ fhir:value "10-12345" ]
];
fhir:PaymentReconciliation.detail [
fhir:index 0;
fhir:PaymentReconciliation.detail.identifier [
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/payment/2018/detail" ];
fhir:Identifier.value [ fhir:value "10-12345-001" ]
];
fhir:PaymentReconciliation.detail.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payment-type" ];
fhir:Coding.code [ fhir:value "payment" ]
]
];
fhir:PaymentReconciliation.detail.request [
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://happyvalleyclinic.com/claim" ];
fhir:Identifier.value [ fhir:value "AB12345" ]
]
];
fhir:PaymentReconciliation.detail.submitter [
fhir:link ;
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:PaymentReconciliation.detail.response [
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/claimresponse" ];
fhir:Identifier.value [ fhir:value "CR20140815-AB12345" ]
]
];
fhir:PaymentReconciliation.detail.date [ fhir:value "2014-08-16"^^xsd:date ];
fhir:PaymentReconciliation.detail.payee [
fhir:link ;
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:PaymentReconciliation.detail.amount [
fhir:Money.value [ fhir:value "3500.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 1;
fhir:PaymentReconciliation.detail.identifier [
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/payment/2018/detail" ];
fhir:Identifier.value [ fhir:value "10-12345-002" ]
];
fhir:PaymentReconciliation.detail.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payment-type" ];
fhir:Coding.code [ fhir:value "payment" ]
]
];
fhir:PaymentReconciliation.detail.request [
fhir:link ;
fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699" ]
];
fhir:PaymentReconciliation.detail.date [ fhir:value "2014-08-12"^^xsd:date ];
fhir:PaymentReconciliation.detail.amount [
fhir:Money.value [ fhir:value "4000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 2;
fhir:PaymentReconciliation.detail.identifier [
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/payment/2018/detail" ];
fhir:Identifier.value [ fhir:value "10-12345-003" ]
];
fhir:PaymentReconciliation.detail.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payment-type" ];
fhir:Coding.code [ fhir:value "advance" ]
]
];
fhir:PaymentReconciliation.detail.date [ fhir:value "2014-08-16"^^xsd:date ];
fhir:PaymentReconciliation.detail.amount [
fhir:Money.value [ fhir:value "-1500.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
];
fhir:PaymentReconciliation.formCode [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://ncforms.org/formid" ];
fhir:Coding.code [ fhir:value "PAYREC/2016/01B" ]
]
];
fhir:PaymentReconciliation.processNote [
fhir:index 0;
fhir:PaymentReconciliation.processNote.type [ fhir:value "display" ];
fhir:PaymentReconciliation.processNote.text [ fhir:value "Due to the year end holiday the cutoff for submissions for December will be the 28th." ]
] .
a fhir:Organization .
a fhir:Organization .
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI .
# -------------------------------------------------------------------------------------