Claim/Claim-predetermination-example-01 - TTL Representation - FHIR Implementation Guide for ABDM v7.0.0

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: 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 rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

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

<http://hl7.org/fhir/Claim/Claim-predetermination-example-01> a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "Claim-predetermination-example-01"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim" ;
       fhir:index 0 ;
       fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim>
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.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><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Claim.html\">Claim</a></p></div><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>"
  ] ;
  fhir:Claim.identifier [
     fhir:index 0 ;
     fhir:Identifier.value [ fhir:value "7612345" ]
  ] ;
  fhir:Claim.status [ fhir:value "active"] ;
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       a sct:737481003 ;
       fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
       fhir:Coding.code [ fhir:value "737481003" ] ;
       fhir:Coding.display [ fhir:value "Inpatient care management (procedure)" ]
     ]
  ] ;
  fhir:Claim.subType [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-claimsubtype" ] ;
       fhir:Coding.code [ fhir:value "emergency" ]
     ]
  ] ;
  fhir:Claim.use [ fhir:value "predetermination"] ;
  fhir:Claim.patient [
     fhir:link <http://hl7.org/fhir/Patient/example-01> ;
     fhir:Reference.reference [ fhir:value "Patient/example-01" ]
  ] ;
  fhir:Claim.billablePeriod [
     fhir:Period.start [ fhir:value "2025-03-07T11:01:00+05:00"^^xsd:dateTime ] ;
     fhir:Period.end [ fhir:value "2025-04-07T11:01:00+05:00"^^xsd:dateTime ]
  ] ;
  fhir:Claim.created [ fhir:value "2025-03-07T11:01:00+05:00"^^xsd:dateTime] ;
  fhir:Claim.insurer [
     fhir:link <http://hl7.org/fhir/Organization/example-02> ;
     fhir:Reference.reference [ fhir:value "Organization/example-02" ]
  ] ;
  fhir:Claim.provider [
     fhir:link <http://hl7.org/fhir/Organization/example-03> ;
     fhir:Reference.reference [ fhir:value "Organization/example-03" ]
  ] ;
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ] ;
       fhir:Coding.code [ fhir:value "normal" ]
     ]
  ] ;
  fhir:Claim.careTeam [
     fhir:index 0 ;
     fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.careTeam.provider [
       fhir:link <http://hl7.org/fhir/Practitioner/example-01> ;
       fhir:Reference.reference [ fhir:value "Practitioner/example-01" ]
     ] ;
     fhir:Claim.careTeam.role [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         a sct:223366009 ;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
         fhir:Coding.code [ fhir:value "223366009" ] ;
         fhir:Coding.display [ fhir:value "Healthcare professional (occupation)" ]
       ]
     ] ;
     fhir:Claim.careTeam.qualification [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         a sct:394658006 ;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
         fhir:Coding.code [ fhir:value "394658006" ] ;
         fhir:Coding.display [ fhir:value "Clinical specialty (qualifier value)" ]
       ]
     ]
  ] ;
  fhir:Claim.diagnosis [
     fhir:index 0 ;
     fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10" ] ;
         fhir:Coding.code [ fhir:value "I46.9" ] ;
         fhir:Coding.display [ fhir:value "Cardiac arrest, unspecified" ]
       ]
     ] ;
     fhir:Claim.diagnosis.type [
       fhir:index 0 ;
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         a sct:89100005 ;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
         fhir:Coding.code [ fhir:value "89100005" ] ;
         fhir:Coding.display [ fhir:value "Final diagnosis (discharge) (contextual qualifier) (qualifier value)" ]
       ]
     ]
  ] ;
  fhir:Claim.procedure [
     fhir:index 0 ;
     fhir:Claim.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.procedure.procedureCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         a sct:77343006 ;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
         fhir:Coding.code [ fhir:value "77343006" ] ;
         fhir:Coding.display [ fhir:value "Angiography" ]
       ]
     ]
  ], [
     fhir:index 1 ;
     fhir:Claim.procedure.sequence [ fhir:value "2"^^xsd:positiveInteger ] ;
     fhir:Claim.procedure.procedureCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         a sct:418285008 ;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
         fhir:Coding.code [ fhir:value "418285008" ] ;
         fhir:Coding.display [ fhir:value "Angioplasty of blood vessel" ]
       ]
     ]
  ] ;
  fhir:Claim.insurance [
     fhir:index 0 ;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ] ;
     fhir:Claim.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/example-01> ;
       fhir:Reference.reference [ fhir:value "Coverage/example-01" ]
     ]
  ] ;
  fhir:Claim.item [
     fhir:index 0 ;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger ;
       fhir:index 0
     ] ;
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         a sct:77343006 ;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
         fhir:Coding.code [ fhir:value "77343006" ] ;
         fhir:Coding.display [ fhir:value "Angiography" ]
       ]
     ] ;
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "INR" ]
     ] ;
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "INR" ]
     ]
  ], [
     fhir:index 1 ;
     fhir:Claim.item.sequence [ fhir:value "2"^^xsd:positiveInteger ] ;
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger ;
       fhir:index 0
     ] ;
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         a sct:418285008 ;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
         fhir:Coding.code [ fhir:value "418285008" ] ;
         fhir:Coding.display [ fhir:value "Angioplasty of blood vessel" ]
       ]
     ] ;
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "40000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "INR" ]
     ] ;
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "40000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "INR" ]
     ]
  ], [
     fhir:index 2 ;
     fhir:Claim.item.sequence [ fhir:value "3"^^xsd:positiveInteger ] ;
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger ;
       fhir:index 0
     ] ;
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         a sct:309904001 ;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
         fhir:Coding.code [ fhir:value "309904001" ] ;
         fhir:Coding.display [ fhir:value "Intensive care unit" ]
       ]
     ] ;
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "2000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "INR" ]
     ] ;
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "20000"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "INR" ]
     ]
  ] ;
  fhir:Claim.total [
     fhir:Money.value [ fhir:value "70000"^^xsd:decimal ] ;
     fhir:Money.currency [ fhir:value "INR" ]
  ] .

<http://hl7.org/fhir/Patient/example-01> a fhir:Patient .

<http://hl7.org/fhir/Organization/example-02> a fhir:Organization .

<http://hl7.org/fhir/Organization/example-03> a fhir:Organization .

<http://hl7.org/fhir/Practitioner/example-01> a fhir:Practitioner .

<http://hl7.org/fhir/Coverage/example-01> a fhir:Coverage .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Claim/Claim-predetermination-example-01.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/Claim/Claim-predetermination-example-01.ttl> .