Consumer-Directed Payer Data Exchange
- Release 0.1.0

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

Raw ttl

@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.