This page is part of a downloaded copy of this specification. This page is part of the CARIN Blue Button Implementation Guide (v0.1.0: STU1 Ballot 1) based on FHIR R4. For a full list of available versions, see the Directory of published versions
Turtle Format: ExplanationOfBenefit-EOB1
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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 xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- a fhir:ExplanationOfBenefit; fhir:nodeRole fhir:treeRoot; fhir:Resource.id [ fhir:value "EOB1"]; fhir:Resource.meta [ fhir:Meta.versionId [ fhir:value "4" ]; fhir:Meta.lastUpdated [ fhir:value "2019-12-18T22:49:23.000-05:00"^^xsd:dateTime ]; fhir:Meta.profile [ fhir:value "http://hl7.org/fhir/us/carin/StructureDefinition/carin-bb-explanationofbenefit"; fhir:index 0; fhir:link <http://hl7.org/fhir/us/carin/StructureDefinition/carin-bb-explanationofbenefit> ] ]; fhir:DomainResource.text [ fhir:Narrative.status [ fhir:value "generated" ]; fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p>\n <b>Generated Narrative with Details</b>\n </p>\n </div>" ]; fhir:ExplanationOfBenefit.identifier [ fhir:index 0; fhir:Identifier.system [ fhir:value "http://www.bcbs.com/fhir/ns/NamingSystem/explanationOfBenefit-identifier" ]; fhir:Identifier.value [ fhir:value "4E93-BE91-EAC1977941A8" ] ]; fhir:ExplanationOfBenefit.status [ fhir:value "active"]; fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claim-type" ]; fhir:Coding.code [ fhir:value "inpatient-facility" ]; fhir:Coding.display [ fhir:value "Inpatient Facility" ] ] ]; fhir:ExplanationOfBenefit.use [ fhir:value "claim"]; fhir:ExplanationOfBenefit.patient [ fhir:Reference.reference [ fhir:value "Patient/Patient1" ] ]; fhir:ExplanationOfBenefit.billablePeriod [ fhir:Period.start [ fhir:value "2017-04-05"^^xsd:date ]; fhir:Period.end [ fhir:value "2017-04-14"^^xsd:date ] ]; fhir:ExplanationOfBenefit.created [ fhir:value "2017-04-15"^^xsd:date]; fhir:ExplanationOfBenefit.insurer [ fhir:Reference.reference [ fhir:value "Organization/Org45" ] ]; fhir:ExplanationOfBenefit.provider [ fhir:Reference.reference [ fhir:value "Organization/Org1" ] ]; fhir:ExplanationOfBenefit.outcome [ fhir:value "complete"]; fhir:ExplanationOfBenefit.careTeam [ fhir:index 0; fhir:ExplanationOfBenefit.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.careTeam.provider [ fhir:Reference.reference [ fhir:value "PractitionerRole/PractitionerRole1" ] ]; fhir:ExplanationOfBenefit.careTeam.responsible [ fhir:value "true"^^xsd:boolean ]; fhir:ExplanationOfBenefit.careTeam.role [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "supervising" ]; fhir:Coding.display [ fhir:value "Attending or Supervising provider" ] ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.careTeam.sequence [ fhir:value "2"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.careTeam.provider [ fhir:Reference.reference [ fhir:value "PractitionerRole/PractitionerRole1" ] ]; fhir:ExplanationOfBenefit.careTeam.responsible [ fhir:value "false"^^xsd:boolean ]; fhir:ExplanationOfBenefit.careTeam.role [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "performing" ]; fhir:Coding.display [ fhir:value "Servicing or Rendering provider" ] ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.careTeam.sequence [ fhir:value "3"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.careTeam.provider [ fhir:Reference.reference [ fhir:value "PractitionerRole/PractitionerRole1" ] ]; fhir:ExplanationOfBenefit.careTeam.responsible [ fhir:value "false"^^xsd:boolean ]; fhir:ExplanationOfBenefit.careTeam.role [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "prescribing" ]; fhir:Coding.display [ fhir:value "Prescribing provider" ] ] ] ]; fhir:ExplanationOfBenefit.supportingInfo [ fhir:index 0; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory" ]; fhir:Coding.code [ fhir:value "billingnetworkcontractingstatus" ] ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory" ]; fhir:Coding.code [ fhir:value "attendingnetworkcontractingstatus" ] ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "3"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory" ]; fhir:Coding.code [ fhir:value "clmrecvddate" ] ] ]; fhir:ExplanationOfBenefit.supportingInfo.timingDate [ fhir:value "2017-04-12"^^xsd:date ] ], [ fhir:index 3; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "4"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory" ]; fhir:Coding.code [ fhir:value "typeofservice" ] ] ] ], [ fhir:index 4; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "5"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory" ]; fhir:Coding.code [ fhir:value "tob-typeoffacility" ] ] ] ], [ fhir:index 5; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "6"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory" ]; fhir:Coding.code [ fhir:value "tob-billclassification" ] ] ] ], [ fhir:index 6; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "7"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory" ]; fhir:Coding.code [ fhir:value "tob-frequency" ] ] ] ], [ fhir:index 7; fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "8"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.supportingInfo.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory" ]; fhir:Coding.code [ fhir:value "admsrc" ] ] ] ]; fhir:ExplanationOfBenefit.diagnosis [ fhir:index 0; fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ]; fhir:Coding.code [ fhir:value "A30.1" ]; fhir:Coding.display [ fhir:value "Tuberculoid leprosy" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ]; fhir:Coding.code [ fhir:value "principal" ]; fhir:Coding.display [ fhir:value "Principal diagnosis" ] ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "2"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ]; fhir:Coding.code [ fhir:value "S40.861A" ]; fhir:Coding.display [ fhir:value "Diagnosis description 1" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ]; fhir:Coding.code [ fhir:value "principal" ]; fhir:Coding.display [ fhir:value "Principal diagnosis" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.onAdmission [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosis-on-admission" ]; fhir:Coding.code [ fhir:value "y" ]; fhir:Coding.display [ fhir:value "Yes" ] ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "3"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ]; fhir:Coding.code [ fhir:value "A05.1" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ]; fhir:Coding.code [ fhir:value "admitting" ]; fhir:Coding.display [ fhir:value "Admitting Diagnosis" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.onAdmission [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosis-on-admission" ]; fhir:Coding.code [ fhir:value "n" ]; fhir:Coding.display [ fhir:value "No" ] ] ] ], [ fhir:index 3; fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "4"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ]; fhir:Coding.code [ fhir:value "A37.00" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ]; fhir:Coding.code [ fhir:value "admitting" ]; fhir:Coding.display [ fhir:value "Admitting Diagnosis" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.onAdmission [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosis-on-admission" ]; fhir:Coding.code [ fhir:value "y" ]; fhir:Coding.display [ fhir:value "Yes" ] ] ] ], [ fhir:index 4; fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "5"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ]; fhir:Coding.code [ fhir:value "G44.221" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ]; fhir:Coding.code [ fhir:value "admitting" ]; fhir:Coding.display [ fhir:value "Admitting Diagnosis" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.onAdmission [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosis-on-admission" ]; fhir:Coding.code [ fhir:value "u" ]; fhir:Coding.display [ fhir:value "Unknown" ] ] ] ], [ fhir:index 5; fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "6"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ]; fhir:Coding.code [ fhir:value "I11.9" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ]; fhir:Coding.code [ fhir:value "admitting" ]; fhir:Coding.display [ fhir:value "Admitting Diagnosis" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.onAdmission [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosis-on-admission" ]; fhir:Coding.code [ fhir:value "y" ]; fhir:Coding.display [ fhir:value "Yes" ] ] ] ], [ fhir:index 6; fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "7"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ]; fhir:Coding.code [ fhir:value "A31.1" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ]; fhir:Coding.code [ fhir:value "admitting" ]; fhir:Coding.display [ fhir:value "Admitting Diagnosis" ] ] ]; fhir:ExplanationOfBenefit.diagnosis.onAdmission [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosis-on-admission" ]; fhir:Coding.code [ fhir:value "y" ]; fhir:Coding.display [ fhir:value "Yes" ] ] ] ]; fhir:ExplanationOfBenefit.procedure [ fhir:index 0; fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.procedure.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-procedure-type" ]; fhir:Coding.code [ fhir:value "primary" ] ] ]; fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2017-04-05"^^xsd:date ]; fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ]; fhir:Coding.code [ fhir:value "3E00X28" ]; fhir:Coding.display [ fhir:value "Introduction of Oxazolidinones into Skin and Mucous Membranes, External Approach" ] ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "2"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2017-04-06"^^xsd:date ]; fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ]; fhir:Coding.code [ fhir:value "8E01XY7" ]; fhir:Coding.display [ fhir:value "Examination of Nervous System" ] ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "3"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.procedure.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-procedure-type" ]; fhir:Coding.code [ fhir:value "secondary" ] ] ]; fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2017-04-07"^^xsd:date ]; fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ]; fhir:Coding.code [ fhir:value "8E023DZ" ]; fhir:Coding.display [ fhir:value "Near Infrared Spectroscopy of Circulatory System, Percutaneous Approach" ] ] ] ], [ fhir:index 3; fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "4"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.procedure.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-procedure-type" ]; fhir:Coding.code [ fhir:value "secondary" ] ] ]; fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2017-04-08"^^xsd:date ]; fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ]; fhir:Coding.code [ fhir:value "02114A3" ]; fhir:Coding.display [ fhir:value "Bypass Coronary Artery, Two Arteries from Coronary Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach" ] ] ] ], [ fhir:index 4; fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "5"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.procedure.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-procedure-type" ]; fhir:Coding.code [ fhir:value "secondary" ] ] ]; fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2017-04-09"^^xsd:date ]; fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ]; fhir:Coding.code [ fhir:value "0FN57ZZ" ]; fhir:Coding.display [ fhir:value "Release Right Hepatic Duct, Via Natural or Artificial Opening" ] ] ] ], [ fhir:index 5; fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "6"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.procedure.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-procedure-type" ]; fhir:Coding.code [ fhir:value "secondary" ] ] ]; fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2017-04-10"^^xsd:date ]; fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ]; fhir:Coding.code [ fhir:value "0LQ83ZZ" ]; fhir:Coding.display [ fhir:value "Repair Left Hand Tendon, Percutaneous Approach" ] ] ] ]; fhir:ExplanationOfBenefit.insurance [ fhir:index 0; fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ]; fhir:ExplanationOfBenefit.insurance.coverage [ fhir:Reference.reference [ fhir:value "Coverage/Coverage1" ] ] ]; fhir:ExplanationOfBenefit.item [ fhir:index 0; fhir:ExplanationOfBenefit.item.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.item.careTeamSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.diagnosisSequence [ fhir:value "2"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.procedureSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.informationSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.revenue [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ]; fhir:Coding.code [ fhir:value "0450" ] ] ]; fhir:ExplanationOfBenefit.item.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ]; fhir:Coding.code [ fhir:value "1" ]; fhir:Coding.display [ fhir:value "Medical Care" ] ] ]; fhir:ExplanationOfBenefit.item.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-USCLS" ]; fhir:Coding.code [ fhir:value "1101" ]; fhir:Coding.display [ fhir:value "Exam, comp, primary" ] ] ]; fhir:ExplanationOfBenefit.item.quantity [ fhir:Quantity.value [ fhir:value "6"^^xsd:decimal ] ]; fhir:ExplanationOfBenefit.item.adjudication [ fhir:index 0; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "submitted" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "8000"^^xsd:decimal ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "eligible" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "8000"^^xsd:decimal ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "deductible" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "5000"^^xsd:decimal ] ] ], [ fhir:index 3; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "copay" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "100"^^xsd:decimal ] ] ], [ fhir:index 4; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "2400"^^xsd:decimal ] ] ], [ fhir:index 5; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "tax" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.item.sequence [ fhir:value "2"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.item.careTeamSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.diagnosisSequence [ fhir:value "2"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.procedureSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.informationSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.revenue [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ]; fhir:Coding.code [ fhir:value "0450" ] ] ]; fhir:ExplanationOfBenefit.item.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ]; fhir:Coding.code [ fhir:value "1" ]; fhir:Coding.display [ fhir:value "Medical Care" ] ] ]; fhir:ExplanationOfBenefit.item.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-USCLS" ]; fhir:Coding.code [ fhir:value "1101" ]; fhir:Coding.display [ fhir:value "Exam, comp, primary" ] ] ]; fhir:ExplanationOfBenefit.item.quantity [ fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ] ]; fhir:ExplanationOfBenefit.item.adjudication [ fhir:index 0; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "submitted" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "750"^^xsd:decimal ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "eligible" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "deductible" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "750"^^xsd:decimal ] ] ], [ fhir:index 3; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [ fhir:index 4; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.text [ fhir:value "copay" ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "750"^^xsd:decimal ] ] ], [ fhir:index 5; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "tax" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.item.sequence [ fhir:value "3"^^xsd:positiveInteger ]; fhir:ExplanationOfBenefit.item.careTeamSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.diagnosisSequence [ fhir:value "2"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.procedureSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.informationSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:ExplanationOfBenefit.item.revenue [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-revenue-center" ]; fhir:Coding.code [ fhir:value "0370" ] ] ]; fhir:ExplanationOfBenefit.item.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ]; fhir:Coding.code [ fhir:value "1" ]; fhir:Coding.display [ fhir:value "Medical Care" ] ] ]; fhir:ExplanationOfBenefit.item.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-USCLS" ]; fhir:Coding.code [ fhir:value "1205" ]; fhir:Coding.display [ fhir:value "Exam, emergency" ] ] ]; fhir:ExplanationOfBenefit.item.quantity [ fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ] ]; fhir:ExplanationOfBenefit.item.adjudication [ fhir:index 0; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "submitted" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "250"^^xsd:decimal ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "eligible" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "deductible" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "250"^^xsd:decimal ] ] ], [ fhir:index 3; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ], [ fhir:index 4; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "copay" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "250"^^xsd:decimal ] ] ], [ fhir:index 5; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "tax" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ] ]; fhir:ExplanationOfBenefit.adjudication [ fhir:index 0; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "submitted" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "9000"^^xsd:decimal ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "eligible" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "8000"^^xsd:decimal ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "deductible" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "5000"^^xsd:decimal ] ] ], [ fhir:index 3; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "copay" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "100"^^xsd:decimal ] ] ], [ fhir:index 4; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "2400"^^xsd:decimal ] ] ], [ fhir:index 5; fhir:ExplanationOfBenefit.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "tax" ] ] ]; fhir:ExplanationOfBenefit.item.adjudication.amount [ fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ] ]; fhir:ExplanationOfBenefit.total [ fhir:index 0; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory" ]; fhir:Coding.code [ fhir:value "submittedamount" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "9000"^^xsd:decimal ] ] ], [ fhir:index 1; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory" ]; fhir:Coding.code [ fhir:value "allowedamount" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "8000"^^xsd:decimal ] ] ], [ fhir:index 2; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory" ]; fhir:Coding.code [ fhir:value "deductibleamount" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "5000"^^xsd:decimal ] ] ], [ fhir:index 3; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory" ]; fhir:Coding.code [ fhir:value "coinsuranceamount" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "80"^^xsd:decimal ] ] ], [ fhir:index 4; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory" ]; fhir:Coding.code [ fhir:value "copayamount" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "100"^^xsd:decimal ] ] ], [ fhir:index 5; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory" ]; fhir:Coding.code [ fhir:value "noncoveredamount" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "1000"^^xsd:decimal ] ] ], [ fhir:index 6; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory" ]; fhir:Coding.code [ fhir:value "paymentamount" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "2400"^^xsd:decimal ] ] ], [ fhir:index 7; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory" ]; fhir:Coding.code [ fhir:value "patientpayamount" ] ] ]; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "6600"^^xsd:decimal ] ] ]; fhir:ExplanationOfBenefit.payment [ fhir:ExplanationOfBenefit.payment.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-paymenttype" ]; fhir:Coding.code [ fhir:value "partial" ] ] ]; fhir:ExplanationOfBenefit.payment.date [ fhir:value "2017-05-12"^^xsd:date ] ]. # - ontology header ------------------------------------------------------------ a owl:Ontology; owl:imports fhir:fhir.ttl.