Finance and Insurance Service (FAIS)
1.0.0 - trial-use International flag

This page is part of the IHE ITI Finance and Insurance Services (v1.0.0: Publication) 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

: Use Case 3 - Example accepted claim response bundle - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <https://loinc.org/rdf/> .
@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 -------------------------------------------------------------------

 a fhir:Bundle ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "ex-claim-response-acc-bundle-3"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse.Bundle"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse.Bundle>     ] )
  ] ; # 
  fhir:type [ fhir:v "collection"] ; # 
  fhir:entry ( [
fhir:fullUrl [ fhir:v "https://profiles.ihe.net/ITI/FAIS/ClaimResponse/ex-claim-response-acc-3"^^xsd:anyURI ] ;
    ( fhir:resource <https://profiles.ihe.net/ITI/FAIS/ClaimResponse/ex-claim-response-acc-3> )
  ] [
fhir:fullUrl [ fhir:v "https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1"^^xsd:anyURI ] ;
    ( fhir:resource <https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1> )
  ] [
fhir:fullUrl [ fhir:v "https://profiles.ihe.net/ITI/FAIS/Claim/ex-claim-3"^^xsd:anyURI ] ;
    ( fhir:resource <https://profiles.ihe.net/ITI/FAIS/Claim/ex-claim-3> )
  ] [
fhir:fullUrl [ fhir:v "https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1"^^xsd:anyURI ] ;
    ( fhir:resource <https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1> )
  ] [
fhir:fullUrl [ fhir:v "https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1"^^xsd:anyURI ] ;
    ( fhir:resource <https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1> )
  ] ) . # 

<https://profiles.ihe.net/ITI/FAIS/ClaimResponse/ex-claim-response-acc-3> a fhir:ClaimResponse ;
  fhir:id [ fhir:v "ex-claim-response-acc-3"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_ex-claim-response-acc-3\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse ex-claim-response-acc-3</b></p><a name=\"ex-claim-response-acc-3\"> </a><a name=\"hcex-claim-response-acc-3\"> </a><a name=\"ex-claim-response-acc-3-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>created</b>: 2024-07-16 03:00:00+0000</p><p><b>insurer</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p><p><b>request</b>: <a href=\"Claim-ex-claim-3.html\">Claim: status = active; type = Institutional; use = claim; created = 2024-07-15 03:00:00+0000; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Accepted</p><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-ex-coverage-1.html\">Coverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --&gt; 2024-12-31</a></td></tr></table></div>"
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "institutional" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:patient [
fhir:reference [ fhir:v "Patient/ex-beneficiary-1" ]
  ] ; # 
  fhir:created [ fhir:v "2024-07-16T03:00:00Z"^^xsd:dateTime] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/ex-insurer-1" ]
  ] ; # 
  fhir:request [
fhir:reference [ fhir:v "Claim/ex-claim-3" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:disposition [ fhir:v "Accepted"] ; # 
  fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/ex-coverage-1" ]     ]
  ] ) . # 

<https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1> a fhir:Patient ;
  fhir:id [ fhir:v "ex-beneficiary-1"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_ex-beneficiary-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient ex-beneficiary-1</b></p><a name=\"ex-beneficiary-1\"> </a><a name=\"hcex-beneficiary-1\"> </a><a name=\"ex-beneficiary-1-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Purity Atieno  Female, DoB: 2000-05-04</p><hr/></div>"
  ] ; # 
  fhir:name ( [
fhir:family [ fhir:v "Atieno" ] ;
    ( fhir:given [ fhir:v "Purity" ] )
  ] ) ; # 
  fhir:gender [ fhir:v "female"] ; # 
  fhir:birthDate [ fhir:v "2000-05-04"^^xsd:date] . # 

<https://profiles.ihe.net/ITI/FAIS/Claim/ex-claim-3> a fhir:Claim ;
  fhir:id [ fhir:v "ex-claim-3"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim"^^xsd:anyURI ;
fhir:link <https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_ex-claim-3\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim ex-claim-3</b></p><a name=\"ex-claim-3\"> </a><a name=\"hcex-claim-3\"> </a><a name=\"ex-claim-3-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>created</b>: 2024-07-15 03:00:00+0000</p><p><b>enterer</b>: <a href=\"Practitioner-ex-doctor-2.html\">Practitioner Kalu Kalu </a></p><p><b>insurer</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p><p><b>provider</b>: <a href=\"Practitioner-ex-doctor-2.html\">Practitioner Kalu Kalu </a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td><td><a href=\"Organization-ex-network-1.html\">Organization National Health Hospital System</a></td></tr></table><p><b>facility</b>: <a href=\"Location-ex-hospital-2.html\">Location Local Hospital</a></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://id.who.int/icd/release/11/mms XH1VB1}\">Hybrid oncocytic chromophobe tumour</span></td></tr></table><h3>Procedures</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Procedure[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://loinc.org 21946-9}\">Chemotherapy treatment Cancer</span></td></tr></table><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-ex-coverage-1.html\">Coverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --&gt; 2024-12-31</a></td></tr></table></div>"
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "institutional" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:patient [
fhir:reference [ fhir:v "Patient/ex-beneficiary-1" ]
  ] ; # 
  fhir:created [ fhir:v "2024-07-15T03:00:00Z"^^xsd:dateTime] ; # 
  fhir:enterer [
fhir:reference [ fhir:v "Practitioner/ex-doctor-2" ]
  ] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/ex-insurer-1" ]
  ] ; # 
  fhir:provider [
fhir:reference [ fhir:v "Practitioner/ex-doctor-2" ]
  ] ; # 
  fhir:priority [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
fhir:code [ fhir:v "normal" ]     ] )
  ] ; # 
  fhir:payee [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ;
fhir:code [ fhir:v "provider" ]       ] )     ] ;
fhir:party [
fhir:reference [ fhir:v "Organization/ex-network-1" ]     ]
  ] ; # 
  fhir:facility [
fhir:reference [ fhir:v "Location/ex-hospital-2" ]
  ] ; # 
  fhir:diagnosis ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:diagnosis [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "http://id.who.int/icd/release/11/mms"^^xsd:anyURI ] ;
fhir:code [ fhir:v "XH1VB1" ] ;
fhir:display [ fhir:v "Hybrid oncocytic chromophobe tumour" ]       ] )     ]
  ] ) ; # 
  fhir:procedure ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:procedure [
a fhir:CodeableConcept ;
      ( fhir:coding [
a loinc:21946-9 ;
fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "21946-9" ] ;
fhir:display [ fhir:v "Chemotherapy treatment Cancer" ]       ] )     ]
  ] ) ; # 
  fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/ex-coverage-1" ]     ]
  ] ) . # 

<https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1> a fhir:Organization ;
  fhir:id [ fhir:v "ex-insurer-1"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_ex-insurer-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization ex-insurer-1</b></p><a name=\"ex-insurer-1\"> </a><a name=\"hcex-insurer-1\"> </a><a name=\"ex-insurer-1-en-US\"> </a><p><b>name</b>: National Health Insurance Scheme</p></div>"
  ] ; # 
  fhir:name [ fhir:v "National Health Insurance Scheme"] . # 

<https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1> a fhir:Coverage ;
  fhir:id [ fhir:v "ex-coverage-1"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_ex-coverage-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage ex-coverage-1</b></p><a name=\"ex-coverage-1\"> </a><a name=\"hcex-coverage-1\"> </a><a name=\"ex-coverage-1-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode PUBLICPOL}\">public healthcare</span></p><p><b>policyHolder</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>subscriber</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>subscriberId</b>: 05710b56-4448-11ef-b676-774a043da147</p><p><b>beneficiary</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno  Female, DoB: 2000-05-04</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2024-01-01 --&gt; 2024-12-31</p><p><b>payor</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p></div>"
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PUBLICPOL" ] ;
fhir:display [ fhir:v "public healthcare" ]     ] )
  ] ; # 
  fhir:policyHolder [
fhir:reference [ fhir:v "Patient/ex-beneficiary-1" ]
  ] ; # 
  fhir:subscriber [
fhir:reference [ fhir:v "Patient/ex-beneficiary-1" ]
  ] ; # 
  fhir:subscriberId [ fhir:v "05710b56-4448-11ef-b676-774a043da147"] ; # 
  fhir:beneficiary [
fhir:reference [ fhir:v "Patient/ex-beneficiary-1" ]
  ] ; # 
  fhir:relationship [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ;
fhir:code [ fhir:v "self" ] ;
fhir:display [ fhir:v "Self" ]     ] )
  ] ; # 
  fhir:period [
fhir:start [ fhir:v "2024-01-01"^^xsd:date ] ;
fhir:end [ fhir:v "2024-12-31"^^xsd:date ]
  ] ; # 
  fhir:payor ( [
fhir:reference [ fhir:v "Organization/ex-insurer-1" ]
  ] ) . #