FHIR Implementation Guide for ABDM
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This page is part of the FHIR Implementation Guide for ABDM (v6.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: Claim/Claim-predetermination-example-01 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - 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 <https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim Claim-predetermination-example-01</b></p><a name=\"Claim-predetermination-example-01\"> </a><a name=\"hcClaim-predetermination-example-01\"> </a><a name=\"Claim-predetermination-example-01-hi-IN\"> </a><p><b>identifier</b>: 7612345</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 737481003}\">Inpatient care management (procedure)</span></p><p><b>subType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-claimsubtype emergency}\">Emergency Claim</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">ABC Male, DoB: 1981-01-12 ( Medical record number: 22-7225-4829-5255)</a></p><p><b>billablePeriod</b>: 2025-03-07 11:01:00+0500 --&gt; 2025-04-07 11:01:00+0500</p><p><b>created</b>: 2025-03-07 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-example-02.html\">Organization XYZ Insurance Co. Ltd.</a></p><p><b>provider</b>: <a href=\"Organization-example-03.html\">Organization XYZ Hospital Co. Ltd.</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-example-01.html\">Practitioner Dr. DEF</a></td><td><span title=\"Codes:{http://snomed.info/sct 223366009}\">Healthcare professional (occupation)</span></td><td><span title=\"Codes:{http://snomed.info/sct 394658006}\">Clinical specialty (qualifier value)</span></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 I46.9}\">Cardiac arrest, unspecified</span></td><td><span title=\"Codes:{http://snomed.info/sct 89100005}\">Final diagnosis (discharge) (contextual qualifier) (qualifier value)</span></td></tr></table><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>procedure</b>: <span title=\"Codes:{http://snomed.info/sct 77343006}\">Angiography</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>procedure</b>: <span title=\"Codes:{http://snomed.info/sct 418285008}\">Angioplasty of blood vessel</span></p></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-example-01.html\">Coverage: identifier = https://xyzinsurance.in/policynumber/#235037120; status = active; type = PAY; subscriberId = ABC123456BI007; relationship = Self; period = (?) --&gt; 2026-03-17</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>: <span title=\"Codes:{http://snomed.info/sct 77343006}\">Angiography</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 418285008}\">Angioplasty of blood vessel</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>40000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>40000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 3</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 309904001}\">Intensive care unit</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>2000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000</td><td>Indian rupee</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>70000</td><td>Indian rupee</td></tr></table></div>"^^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: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:reference [ fhir:v "Organization/example-02" ]
  ] ; # 
  fhir:provider [
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: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: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" ]
  ] . #