@prefix fhir: . @prefix owl: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:ClaimResponse ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "ClaimResponseProfileExample"] ; # fhir:meta [ fhir:profile ( [ fhir:v "https://shr.tiberbuapps.com/fhir/StructureDefinition/ClaimResponse-ke"^^xsd:anyURI ; fhir:link ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "

Generated Narrative: ClaimResponse ClaimResponseProfileExample

identifier: http://example.org/fhir/identifier-type/KMFL12345 (use: official, )

status: Active

type: Professional

subType: Orthodontic Claim

use: Claim

patient: Eliud Kipchoge Kiptun Male, DoB: 1984-11-05 ( Unique Patient Identifier: 123456 (use: official, ))

created: 2020-06-15

insurer: Organization Kenyatta National Hospital

requestor: SHAPractitionerExample

request: Claim: status = active; type = Professional; use = claim; created = 2020-06-15; priority = Normal

outcome: Processing Complete

disposition: Claim settled as per policy.

payeeType: Provider

item

itemSequence: 1

noteNumber: 1

adjudication

category: Tax

reason: Not covered

Amounts

-ValueCurrency
*100Kenyan shilling

value: 100

detail

detailSequence: 1

noteNumber: 1

adjudication

subDetail

subDetailSequence: 1

noteNumber: 1

adjudication

ProcessNotes

-NumberTypeTextLanguage
*1DisplayClaim settled as per policy.English

communicationRequest: CommunicationRequest: status = active

Insurances

-SequenceFocalCoverageClaimResponse
*1trueCoverageExampleClaimResponse: status = active; type = Professional; use = claim; created = 2020-06-15; outcome = complete

Errors

-DetailSequenceSubDetailSequenceCode
*11Missing Creation Date
" ] ; # fhir:identifier ( [ fhir:use [ fhir:v "official" ] ; fhir:system [ fhir:v "http://example.org/fhir/identifier-type"^^xsd:anyURI ] ; fhir:value [ fhir:v "KMFL12345" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "professional" ] ; fhir:display [ fhir:v "Professional" ] ] ) ; fhir:text [ fhir:v "Professional" ] ] ; # fhir:subType [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-claimsubtype"^^xsd:anyURI ] ; fhir:code [ fhir:v "ortho" ] ; fhir:display [ fhir:v "Orthodontic Claim" ] ] ) ; fhir:text [ fhir:v "Orthodontic Claim" ] ] ; # fhir:use [ fhir:v "claim"] ; # fhir:patient [ fhir:link ; fhir:reference [ fhir:v "Patient/SHAPatientExample2" ] ] ; # fhir:created [ fhir:v "2020-06-15"^^xsd:date] ; # fhir:insurer [ fhir:link ; fhir:reference [ fhir:v "Organization/SHAOrganizationExample" ] ] ; # fhir:requestor [ fhir:reference [ fhir:v "SHAPractitionerExample" ] ] ; # fhir:request [ fhir:link ; fhir:reference [ fhir:v "Claim/ClaimExample" ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:disposition [ fhir:v "Claim settled as per policy."] ; # fhir:payeeType [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ; fhir:code [ fhir:v "provider" ] ; fhir:display [ fhir:v "Provider" ] ] ) ; fhir:text [ fhir:v "Provider" ] ] ; # fhir:item ( [ fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:noteNumber ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "tax" ] ; fhir:display [ fhir:v "Tax" ] ] ) ; fhir:text [ fhir:v "Tax" ] ] ; fhir:reason [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication-reason"^^xsd:anyURI ] ; fhir:code [ fhir:v "ar001" ] ; fhir:display [ fhir:v "Not covered" ] ] ) ; fhir:text [ fhir:v "Not covered" ] ] ; fhir:amount [ fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:currency [ fhir:v "KES" ] ] ; fhir:value [ fhir:v "100"^^xsd:decimal ] ] ) ; fhir:detail ( [ fhir:detailSequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:noteNumber ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "tax" ] ; fhir:display [ fhir:v "Tax" ] ] ) ; fhir:text [ fhir:v "Tax" ] ] ; fhir:reason [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication-reason"^^xsd:anyURI ] ; fhir:code [ fhir:v "ar001" ] ; fhir:display [ fhir:v "Not covered" ] ] ) ; fhir:text [ fhir:v "Not covered" ] ] ; fhir:amount [ fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:currency [ fhir:v "KES" ] ] ; fhir:value [ fhir:v "100"^^xsd:decimal ] ] ) ; fhir:subDetail ( [ fhir:subDetailSequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:noteNumber ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "tax" ] ; fhir:display [ fhir:v "Tax" ] ] ) ; fhir:text [ fhir:v "Tax" ] ] ; fhir:reason [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication-reason"^^xsd:anyURI ] ; fhir:code [ fhir:v "ar001" ] ; fhir:display [ fhir:v "Not covered" ] ] ) ; fhir:text [ fhir:v "Not covered" ] ] ; fhir:amount [ fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:currency [ fhir:v "KES" ] ] ; fhir:value [ fhir:v "100"^^xsd:decimal ] ] ) ] ) ] ) ] ) ; # fhir:processNote ( [ fhir:number [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:type [ fhir:v "display" ] ; fhir:text [ fhir:v "Claim settled as per policy." ] ; fhir:language [ fhir:coding ( [ fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ; fhir:code [ fhir:v "en" ] ; fhir:display [ fhir:v "English" ] ] ) ; fhir:text [ fhir:v "English" ] ] ] ) ; # fhir:communicationRequest ( [ fhir:link ; fhir:reference [ fhir:v "CommunicationRequest/CommunicationRequestExample" ] ] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v "true"^^xsd:boolean ] ; fhir:coverage [ fhir:reference [ fhir:v "CoverageExample" ] ] ; fhir:claimResponse [ fhir:link ; fhir:reference [ fhir:v "ClaimResponse/ClaimResponseExample" ] ] ] ) ; # fhir:error ( [ fhir:detailSequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:subDetailSequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:code [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication-error"^^xsd:anyURI ] ; fhir:code [ fhir:v "a001" ] ; fhir:display [ fhir:v "Missing Creation Date" ] ] ) ; fhir:text [ fhir:v "Missing Creation Date" ] ] ] ) . # # -------------------------------------------------------------------------------------