@prefix fhir: . @prefix owl: . @prefix rdf: . @prefix rdfs: . @prefix sct: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:Claim ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "Claim-predetermination-example-01"] ; # fhir:meta [ fhir:profile ( [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"^^xsd:anyURI ; fhir:link ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "

Generated Narrative: Claim Claim-predetermination-example-01

identifier: 7612345

status: Active

type: Inpatient care management (procedure)

subType: Emergency Claim

use: Predetermination

patient: ABC Male, DoB: 1981-01-12 ( Medical record number: 22-7225-4829-5255)

billablePeriod: 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500

created: 2025-03-07 11:01:00+0500

insurer: Organization XYZ Insurance Co. Ltd.

provider: Organization XYZ Hospital Co. Ltd.

priority: Normal

CareTeams

-SequenceProviderRoleQualification
*1Practitioner Dr. DEFHealthcare professional (occupation)Clinical specialty (qualifier value)

Diagnoses

-SequenceDiagnosis[x]Type
*1Cardiac arrest, unspecifiedFinal diagnosis (discharge) (contextual qualifier) (qualifier value)

procedure

sequence: 1

procedure: Angiography

procedure

sequence: 2

procedure: Angioplasty of blood vessel

Insurances

-SequenceFocalCoverage
*1trueCoverage: identifier = https://xyzinsurance.in/policynumber/#235037120; status = active; type = PAY; subscriberId = ABC123456BI007; relationship = Self; period = (?) --> 2026-03-17

item

sequence: 1

careTeamSequence: 1

productOrService: Angiography

UnitPrices

-ValueCurrency
*10000Indian rupee

Nets

-ValueCurrency
*10000Indian rupee

item

sequence: 2

careTeamSequence: 1

productOrService: Angioplasty of blood vessel

UnitPrices

-ValueCurrency
*40000Indian rupee

Nets

-ValueCurrency
*40000Indian rupee

item

sequence: 3

careTeamSequence: 1

productOrService: Intensive care unit

UnitPrices

-ValueCurrency
*2000Indian rupee

Nets

-ValueCurrency
*20000Indian rupee

Totals

-ValueCurrency
*70000Indian rupee
"^^rdf:XMLLiteral ] ; # fhir:identifier ( [ fhir:value [ fhir:v "7612345" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ a sct:737481003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "737481003" ] ; fhir:display [ fhir:v "Inpatient care management (procedure)" ] ] ) ] ; # fhir:subType [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-claimsubtype"^^xsd:anyURI ] ; fhir:code [ fhir:v "emergency" ] ] ) ] ; # fhir:use [ fhir:v "predetermination"] ; # fhir:patient [ fhir:link ; fhir:reference [ fhir:v "Patient/example-01" ] ] ; # fhir:billablePeriod [ fhir:start [ fhir:v "2025-03-07T11:01:00+05:00"^^xsd:dateTime ] ; fhir:end [ fhir:v "2025-04-07T11:01:00+05:00"^^xsd:dateTime ] ] ; # fhir:created [ fhir:v "2025-03-07T11:01:00+05:00"^^xsd:dateTime] ; # fhir:insurer [ fhir:link ; fhir:reference [ fhir:v "Organization/example-02" ] ] ; # fhir:provider [ fhir:link ; fhir:reference [ fhir:v "Organization/example-03" ] ] ; # fhir:priority [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; fhir:code [ fhir:v "normal" ] ] ) ] ; # fhir:careTeam ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:provider [ fhir:link ; fhir:reference [ fhir:v "Practitioner/example-01" ] ] ; fhir:role [ fhir:coding ( [ a sct:223366009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "223366009" ] ; fhir:display [ fhir:v "Healthcare professional (occupation)" ] ] ) ] ; fhir:qualification [ fhir:coding ( [ a sct:394658006 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "394658006" ] ; fhir:display [ fhir:v "Clinical specialty (qualifier value)" ] ] ) ] ] ) ; # fhir:diagnosis ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:diagnosis [ a fhir:CodeableConcept ; fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10"^^xsd:anyURI ] ; fhir:code [ fhir:v "I46.9" ] ; fhir:display [ fhir:v "Cardiac arrest, unspecified" ] ] ) ] ; fhir:type ( [ fhir:coding ( [ a sct:89100005 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "89100005" ] ; fhir:display [ fhir:v "Final diagnosis (discharge) (contextual qualifier) (qualifier value)" ] ] ) ] ) ] ) ; # fhir:procedure ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:procedure [ a fhir:CodeableConcept ; fhir:coding ( [ a sct:77343006 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "77343006" ] ; fhir:display [ fhir:v "Angiography" ] ] ) ] ] [ fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:procedure [ a fhir:CodeableConcept ; fhir:coding ( [ a sct:418285008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "418285008" ] ; fhir:display [ fhir:v "Angioplasty of blood vessel" ] ] ) ] ] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v "true"^^xsd:boolean ] ; fhir:coverage [ fhir:link ; fhir:reference [ fhir:v "Coverage/example-01" ] ] ] ) ; # fhir:item ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:77343006 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "77343006" ] ; fhir:display [ fhir:v "Angiography" ] ] ) ] ; fhir:unitPrice [ fhir:value [ fhir:v "10000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:net [ fhir:value [ fhir:v "10000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] [ fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:418285008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "418285008" ] ; fhir:display [ fhir:v "Angioplasty of blood vessel" ] ] ) ] ; fhir:unitPrice [ fhir:value [ fhir:v "40000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:net [ fhir:value [ fhir:v "40000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] [ fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit" ] ] ) ] ; fhir:unitPrice [ fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:net [ fhir:value [ fhir:v "20000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ; # fhir:total [ fhir:value [ fhir:v "70000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] . # # -------------------------------------------------------------------------------------