FHIR Implementation Guide for ABDM
7.0.0 - active
FHIR Implementation Guide for ABDM
7.0.0 - active
FHIR Implementation Guide for ABDM - Local Development build (v7.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2023-07-05 |
@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 xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/ndhm-claim-exclusion> a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "ndhm-claim-exclusion"] ;
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: CodeSystem ndhm-claim-exclusion</b></p><a name=\"ndhm-claim-exclusion\"> </a><a name=\"hcndhm-claim-exclusion\"> </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>"
] ;
fhir:CodeSystem.url [ fhir:value "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion"] ;
fhir:CodeSystem.version [ fhir:value "7.0.0"] ;
fhir:CodeSystem.name [ fhir:value "ClaimExclusion"] ;
fhir:CodeSystem.title [ fhir:value "Claim Exclusion"] ;
fhir:CodeSystem.status [ fhir:value "draft"] ;
fhir:CodeSystem.experimental [ fhir:value "false"^^xsd:boolean] ;
fhir:CodeSystem.date [ fhir:value "2023-07-05"^^xsd:date] ;
fhir:CodeSystem.publisher [ fhir:value "National Resource Center for EHR Standards"] ;
fhir:CodeSystem.contact [
fhir:index 0 ;
fhir:ContactDetail.name [ fhir:value "National Resource Center for EHR Standards" ] ;
fhir:ContactDetail.telecom [
fhir:index 0 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "https://nrces.in/" ]
]
] ;
fhir:CodeSystem.description [ fhir:value "This CodeSystem comprises codes that describes excluded coverage within a health insurance product."] ;
fhir:CodeSystem.jurisdiction [
fhir:index 0 ;
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ;
fhir:Coding.code [ fhir:value "IN" ] ;
fhir:Coding.display [ fhir:value "India" ]
]
] ;
fhir:CodeSystem.caseSensitive [ fhir:value "true"^^xsd:boolean] ;
fhir:CodeSystem.content [ fhir:value "complete"] ;
fhir:CodeSystem.count [ fhir:value "24"^^xsd:nonNegativeInteger] ;
fhir:CodeSystem.concept [
fhir:index 0 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl01" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Pre-Existing Diseases" ]
], [
fhir:index 1 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl02" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Specified disease/procedure waiting period" ]
], [
fhir:index 2 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl03" ] ;
fhir:CodeSystem.concept.display [ fhir:value "30-day waiting period" ]
], [
fhir:index 3 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl04" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Investigation Evaluation" ]
], [
fhir:index 4 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl05" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Rest Cure,Rehabilitation and Respite Care" ]
], [
fhir:index 5 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl06" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Obesity/Weight Control" ]
], [
fhir:index 6 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl07" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Change-of-Gender treatments" ]
], [
fhir:index 7 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl08" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Cosmetic or plastic Surgery" ]
], [
fhir:index 8 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl09" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Hazardous or Adventure sports" ]
], [
fhir:index 9 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl10" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Breach of law" ]
], [
fhir:index 10 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl11" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Excluded Providers" ]
], [
fhir:index 11 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl12" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Rehabilitation" ]
], [
fhir:index 12 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl13" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Hydrotherapy" ]
], [
fhir:index 13 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl14" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Non-prescription" ]
], [
fhir:index 14 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl15" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Refractive Error" ]
], [
fhir:index 15 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl16" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Unproven Treatments" ]
], [
fhir:index 16 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl17" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Sterility and Infertility" ]
], [
fhir:index 17 ;
fhir:CodeSystem.concept.code [ fhir:value "Excl18" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Maternity Expenses" ]
], [
fhir:index 18 ;
fhir:CodeSystem.concept.code [ fhir:value "IIB13" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Fraudulent Claim" ]
], [
fhir:index 19 ;
fhir:CodeSystem.concept.code [ fhir:value "IIB14" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Sum insured exhausted" ]
], [
fhir:index 20 ;
fhir:CodeSystem.concept.code [ fhir:value "IIB15" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Withdrawal by the Insured" ]
], [
fhir:index 21 ;
fhir:CodeSystem.concept.code [ fhir:value "IIB16" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Suppression of Material Information" ]
], [
fhir:index 22 ;
fhir:CodeSystem.concept.code [ fhir:value "IIB17" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Waiting Period beyond 30 days" ]
], [
fhir:index 23 ;
fhir:CodeSystem.concept.code [ fhir:value "IIB20" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Not covered under the Terms and Conditions of the contract" ]
] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/ndhm-claim-exclusion.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/CodeSystem/ndhm-claim-exclusion.ttl> .
IG © 2024+ National Resource Center for EHR Standards. Package ndhm.in#7.0.0 based on FHIR 4.0.1. Generated 2026-07-15
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