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

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• TTL

: Claim Exclusion - TTL Representation

Draft as of 2023-07-05

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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 xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CodeSystem ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "ndhm-claim-exclusion"] ; # 
  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: CodeSystem ndhm-claim-exclusion</b></p><a name=\"ndhm-claim-exclusion\"> </a><a name=\"hcndhm-claim-exclusion\"> </a><a name=\"ndhm-claim-exclusion-hi-IN\"> </a><p>This case-sensitive code system <code>https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td></tr><tr><td style=\"white-space:nowrap\">Excl01<a name=\"ndhm-claim-exclusion-Excl01\"> </a></td><td>Pre-Existing Diseases</td></tr><tr><td style=\"white-space:nowrap\">Excl02<a name=\"ndhm-claim-exclusion-Excl02\"> </a></td><td>Specified disease/procedure waiting period</td></tr><tr><td style=\"white-space:nowrap\">Excl03<a name=\"ndhm-claim-exclusion-Excl03\"> </a></td><td>30-day waiting period</td></tr><tr><td style=\"white-space:nowrap\">Excl04<a name=\"ndhm-claim-exclusion-Excl04\"> </a></td><td>Investigation Evaluation</td></tr><tr><td style=\"white-space:nowrap\">Excl05<a name=\"ndhm-claim-exclusion-Excl05\"> </a></td><td>Rest Cure,Rehabilitation and Respite Care</td></tr><tr><td style=\"white-space:nowrap\">Excl06<a name=\"ndhm-claim-exclusion-Excl06\"> </a></td><td>Obesity/Weight Control</td></tr><tr><td style=\"white-space:nowrap\">Excl07<a name=\"ndhm-claim-exclusion-Excl07\"> </a></td><td>Change-of-Gender treatments</td></tr><tr><td style=\"white-space:nowrap\">Excl08<a name=\"ndhm-claim-exclusion-Excl08\"> </a></td><td>Cosmetic or plastic Surgery</td></tr><tr><td style=\"white-space:nowrap\">Excl09<a name=\"ndhm-claim-exclusion-Excl09\"> </a></td><td>Hazardous or Adventure sports</td></tr><tr><td style=\"white-space:nowrap\">Excl10<a name=\"ndhm-claim-exclusion-Excl10\"> </a></td><td>Breach of law</td></tr><tr><td style=\"white-space:nowrap\">Excl11<a name=\"ndhm-claim-exclusion-Excl11\"> </a></td><td>Excluded Providers</td></tr><tr><td style=\"white-space:nowrap\">Excl12<a name=\"ndhm-claim-exclusion-Excl12\"> </a></td><td>Rehabilitation</td></tr><tr><td style=\"white-space:nowrap\">Excl13<a name=\"ndhm-claim-exclusion-Excl13\"> </a></td><td>Hydrotherapy</td></tr><tr><td style=\"white-space:nowrap\">Excl14<a name=\"ndhm-claim-exclusion-Excl14\"> </a></td><td>Non-prescription</td></tr><tr><td style=\"white-space:nowrap\">Excl15<a name=\"ndhm-claim-exclusion-Excl15\"> </a></td><td>Refractive Error</td></tr><tr><td style=\"white-space:nowrap\">Excl16<a name=\"ndhm-claim-exclusion-Excl16\"> </a></td><td>Unproven Treatments</td></tr><tr><td style=\"white-space:nowrap\">Excl17<a name=\"ndhm-claim-exclusion-Excl17\"> </a></td><td>Sterility and Infertility</td></tr><tr><td style=\"white-space:nowrap\">Excl18<a name=\"ndhm-claim-exclusion-Excl18\"> </a></td><td>Maternity Expenses</td></tr><tr><td style=\"white-space:nowrap\">IIB13<a name=\"ndhm-claim-exclusion-IIB13\"> </a></td><td>Fraudulent Claim</td></tr><tr><td style=\"white-space:nowrap\">IIB14<a name=\"ndhm-claim-exclusion-IIB14\"> </a></td><td>Sum insured exhausted</td></tr><tr><td style=\"white-space:nowrap\">IIB15<a name=\"ndhm-claim-exclusion-IIB15\"> </a></td><td>Withdrawal by the Insured</td></tr><tr><td style=\"white-space:nowrap\">IIB16<a name=\"ndhm-claim-exclusion-IIB16\"> </a></td><td>Suppression of Material Information</td></tr><tr><td style=\"white-space:nowrap\">IIB17<a name=\"ndhm-claim-exclusion-IIB17\"> </a></td><td>Waiting Period beyond 30 days</td></tr><tr><td style=\"white-space:nowrap\">IIB20<a name=\"ndhm-claim-exclusion-IIB20\"> </a></td><td>Not covered under the Terms and Conditions of the contract</td></tr></table></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "6.5.0"] ; # 
  fhir:name [ fhir:v "ClaimExclusion"] ; # 
  fhir:title [ fhir:v "Claim Exclusion"] ; # 
  fhir:status [ fhir:v "draft"] ; # 
  fhir:experimental [ fhir:v "false"^^xsd:boolean] ; # 
  fhir:date [ fhir:v "2023-07-05"^^xsd:date] ; # 
  fhir:publisher [ fhir:v "National Resource Center for EHR Standards"] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "National Resource Center for EHR Standards" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "https://nrces.in/" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "This CodeSystem comprises codes that describes excluded coverage within a health insurance product."] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IN" ] ;
fhir:display [ fhir:v "India" ]     ] )
  ] ) ; # 
  fhir:caseSensitive [ fhir:v "true"^^xsd:boolean] ; # 
  fhir:content [ fhir:v "complete"] ; # 
  fhir:count [ fhir:v "24"^^xsd:nonNegativeInteger] ; # 
  fhir:concept ( [
fhir:code [ fhir:v "Excl01" ] ;
fhir:display [ fhir:v "Pre-Existing Diseases" ]
  ] [
fhir:code [ fhir:v "Excl02" ] ;
fhir:display [ fhir:v "Specified disease/procedure waiting period" ]
  ] [
fhir:code [ fhir:v "Excl03" ] ;
fhir:display [ fhir:v "30-day waiting period" ]
  ] [
fhir:code [ fhir:v "Excl04" ] ;
fhir:display [ fhir:v "Investigation Evaluation" ]
  ] [
fhir:code [ fhir:v "Excl05" ] ;
fhir:display [ fhir:v "Rest Cure,Rehabilitation and Respite Care" ]
  ] [
fhir:code [ fhir:v "Excl06" ] ;
fhir:display [ fhir:v "Obesity/Weight Control" ]
  ] [
fhir:code [ fhir:v "Excl07" ] ;
fhir:display [ fhir:v "Change-of-Gender treatments" ]
  ] [
fhir:code [ fhir:v "Excl08" ] ;
fhir:display [ fhir:v "Cosmetic or plastic Surgery" ]
  ] [
fhir:code [ fhir:v "Excl09" ] ;
fhir:display [ fhir:v "Hazardous or Adventure sports" ]
  ] [
fhir:code [ fhir:v "Excl10" ] ;
fhir:display [ fhir:v "Breach of law" ]
  ] [
fhir:code [ fhir:v "Excl11" ] ;
fhir:display [ fhir:v "Excluded Providers" ]
  ] [
fhir:code [ fhir:v "Excl12" ] ;
fhir:display [ fhir:v "Rehabilitation" ]
  ] [
fhir:code [ fhir:v "Excl13" ] ;
fhir:display [ fhir:v "Hydrotherapy" ]
  ] [
fhir:code [ fhir:v "Excl14" ] ;
fhir:display [ fhir:v "Non-prescription" ]
  ] [
fhir:code [ fhir:v "Excl15" ] ;
fhir:display [ fhir:v "Refractive Error" ]
  ] [
fhir:code [ fhir:v "Excl16" ] ;
fhir:display [ fhir:v "Unproven Treatments" ]
  ] [
fhir:code [ fhir:v "Excl17" ] ;
fhir:display [ fhir:v "Sterility and Infertility" ]
  ] [
fhir:code [ fhir:v "Excl18" ] ;
fhir:display [ fhir:v "Maternity Expenses" ]
  ] [
fhir:code [ fhir:v "IIB13" ] ;
fhir:display [ fhir:v "Fraudulent Claim" ]
  ] [
fhir:code [ fhir:v "IIB14" ] ;
fhir:display [ fhir:v "Sum insured exhausted" ]
  ] [
fhir:code [ fhir:v "IIB15" ] ;
fhir:display [ fhir:v "Withdrawal by the Insured" ]
  ] [
fhir:code [ fhir:v "IIB16" ] ;
fhir:display [ fhir:v "Suppression of Material Information" ]
  ] [
fhir:code [ fhir:v "IIB17" ] ;
fhir:display [ fhir:v "Waiting Period beyond 30 days" ]
  ] [
fhir:code [ fhir:v "IIB20" ] ;
fhir:display [ fhir:v "Not covered under the Terms and Conditions of the contract" ]
  ] ) . #