CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue ButtonĀ®)
2.0.0 - STU 2 US

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: EOB Oral Example 2 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

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

 a fhir:ExplanationOfBenefit;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "EOBOral2"];
  fhir:Resource.meta [
     fhir:Meta.lastUpdated [ fhir:value "2021-10-28T10:23:00-05:00"^^xsd:dateTime ];
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral|2.0.0";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral|2.0.0>     ]
  ];
  fhir:Resource.language [ fhir:value "en-US"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en-US\" lang=\"en-US\"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name=\"EOBOral2\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource ExplanationOfBenefit &quot;EOBOral2&quot; Updated &quot;2021-10-28 10:23:00-0500&quot;  (Language &quot;en-US&quot;) </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html\">C4BB ExplanationOfBenefit Oral (version 2.0.0)</a></p></div><p><b>identifier</b>: Unique Claim ID: 210300012</p><p><b>status</b>: active</p><p><b>type</b>: Oral <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#oral)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-Patient2.html\">Patient/Patient2</a> &quot; TEST&quot;</p><p><b>billablePeriod</b>: 2021-10-01 --&gt; 2021-10-31</p><p><b>created</b>: 2021-10-28 10:23:00-0500</p><p><b>insurer</b>: <a href=\"Organization-DentalPayer1.html\">Organization/DentalPayer1: XXX Health Plan</a> &quot;INSURANCE COMPANY XYZ&quot;</p><p><b>provider</b>: <a href=\"Practitioner-PractitionerDentalProvider1.html\">Practitioner/PractitionerDentalProvider1: XXX Dental Plan</a> &quot; SCHMIDT&quot;</p><p><b>outcome</b>: complete</p><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: Claim Received Date <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#clmrecvddate)</span></p><p><b>timing</b>: 2021-03-18</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 4</p><p><b>category</b>: Service Facility <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#servicefacility)</span></p><p><b>value</b>: <a href=\"Organization-ProviderOrganization1.html\">Organization/ProviderOrganization1</a> &quot;Orange Medical Group&quot;</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 8</p><p><b>category</b>: Patient Account Number <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#patientaccountnumber)</span></p><p><b>value</b>: PATIENTACCTNO3</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 9</p><p><b>category</b>: Additional Body Site <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#additionalbodysite)</span></p><p><b>code</b>: 1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-ADAUniversalToothDesignationSystem.html\">ADA Universal Tooth Designation System</a>#1)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 10</p><p><b>category</b>: Additional Body Site <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#additionalbodysite)</span></p><p><b>code</b>: 2 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-ADAUniversalToothDesignationSystem.html\">ADA Universal Tooth Designation System</a>#2)</span></p></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><a href=\"Coverage-CoverageDental1.html\">Coverage/CoverageDental1</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>informationSequence</b>: 6, 7, 9, 10, 11</p><p><b>productOrService</b>: Intraoral - periapical first radiographic image <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-CDT.html\">Code on Dental Procedures and Nomenclature</a>#D0220)</span></p><p><b>serviced</b>: 2021-10-28</p><p><b>location</b>: Office <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-CMSPlaceofServiceCodes.html\">CMS Place of Service Codes (POS)</a>#11)</span></p><p><b>bodySite</b>: Upper right quadrant <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-ADAAreaOralCavitySystem.html\">American Dental Association Area of Oral Cavity System</a>#10)</span></p><p><b>subSite</b>: Occlusal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSurfaceCodes.html\">US Surface Codes System</a>#O)</span>, Incisal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSurfaceCodes.html\">US Surface Codes System</a>#I)</span></p><blockquote><p><b>adjudication</b></p><p><b>category</b>: Benefit Payment Status <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudicationDiscriminator.html\">C4BB Adjudication Discriminator Code System</a>#benefitpaymentstatus)</span></p><p><b>reason</b>: In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBPayerAdjudicationStatus.html\">C4BB Payer Adjudication Status Code System</a>#innetwork)</span></p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>150</td><td>USD</td></tr></table></blockquote></blockquote><h3>Adjudications</h3><table class=\"grid\"><tr><td>-</td><td><b>Category</b></td><td><b>Reason</b></td></tr><tr><td>*</td><td>Rendering Network Status <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudicationDiscriminator.html\">C4BB Adjudication Discriminator Code System</a>#renderingnetworkstatus)</span></td><td>In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBPayerAdjudicationStatus.html\">C4BB Payer Adjudication Status Code System</a>#innetwork)</span></td></tr><tr><td>*</td><td>Benefit Payment Status <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudicationDiscriminator.html\">C4BB Adjudication Discriminator Code System</a>#benefitpaymentstatus)</span></td><td>In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBPayerAdjudicationStatus.html\">C4BB Payer Adjudication Status Code System</a>#innetwork)</span></td></tr><tr><td>*</td><td>Billing Network Status <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudicationDiscriminator.html\">C4BB Adjudication Discriminator Code System</a>#billingnetworkstatus)</span></td><td>In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBPayerAdjudicationStatus.html\">C4BB Payer Adjudication Status Code System</a>#innetwork)</span></td></tr></table><blockquote><p><b>total</b></p><p><b>category</b>: Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>150</td><td>USD</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Benefit Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#benefit)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>110</td><td>USD</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Discount Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudication.html\">C4BB Adjudication Code System</a>#discount)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>40</td><td>USD</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Amount Paid to Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudication.html\">C4BB Adjudication Code System</a>#paidtoprovider)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>100</td><td>USD</td></tr></table></blockquote></div>"
  ];
  fhir:ExplanationOfBenefit.identifier [
     fhir:index 0;
     fhir:Identifier.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType" ];
         fhir:Coding.code [ fhir:value "uc" ]       ]     ];
     fhir:Identifier.system [ fhir:value "https://www.xxxplan.com/fhir/EOBIdentifier" ];
     fhir:Identifier.value [ fhir:value "210300012" ]
  ];
  fhir:ExplanationOfBenefit.status [ fhir:value "active"];
  fhir:ExplanationOfBenefit.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "oral" ]     ];
     fhir:CodeableConcept.text [ fhir:value "Oral" ]
  ];
  fhir:ExplanationOfBenefit.use [ fhir:value "claim"];
  fhir:ExplanationOfBenefit.patient [
     fhir:Reference.reference [ fhir:value "Patient/Patient2" ]
  ];
  fhir:ExplanationOfBenefit.billablePeriod [
     fhir:Period.start [ fhir:value "2021-10-01"^^xsd:date ];
     fhir:Period.end [ fhir:value "2021-10-31"^^xsd:date ]
  ];
  fhir:ExplanationOfBenefit.created [ fhir:value "2021-10-28T10:23:00-05:00"^^xsd:dateTime];
  fhir:ExplanationOfBenefit.insurer [
     fhir:Reference.reference [ fhir:value "Organization/DentalPayer1" ];
     fhir:Reference.display [ fhir:value "XXX Health Plan" ]
  ];
  fhir:ExplanationOfBenefit.provider [
     fhir:Reference.reference [ fhir:value "Practitioner/PractitionerDentalProvider1" ];
     fhir:Reference.display [ fhir:value "XXX Dental Plan" ]
  ];
  fhir:ExplanationOfBenefit.outcome [ fhir:value "complete"];
  fhir:ExplanationOfBenefit.supportingInfo [
     fhir:index 0;
     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-bb/CodeSystem/C4BBSupportingInfoType" ];
         fhir:Coding.code [ fhir:value "clmrecvddate" ]       ]     ];
     fhir:ExplanationOfBenefit.supportingInfo.timingDate [ fhir:value "2021-03-18"^^xsd:date ]
  ], [
     fhir:index 1;
     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-bb/CodeSystem/C4BBSupportingInfoType" ];
         fhir:Coding.code [ fhir:value "servicefacility" ]       ]     ];
     fhir:ExplanationOfBenefit.supportingInfo.valueReference [
       fhir:Reference.reference [ fhir:value "Organization/ProviderOrganization1" ]     ]
  ], [
     fhir:index 2;
     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-bb/CodeSystem/C4BBSupportingInfoType" ];
         fhir:Coding.code [ fhir:value "patientaccountnumber" ]       ]     ];
     fhir:ExplanationOfBenefit.supportingInfo.valueString [ fhir:value "PATIENTACCTNO3" ]
  ], [
     fhir:index 3;
     fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "9"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
         fhir:Coding.code [ fhir:value "additionalbodysite" ]       ]     ];
     fhir:ExplanationOfBenefit.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ADAUniversalToothDesignationSystem" ];
         fhir:Coding.code [ fhir:value "1" ]       ]     ]
  ], [
     fhir:index 4;
     fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "10"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
         fhir:Coding.code [ fhir:value "additionalbodysite" ]       ]     ];
     fhir:ExplanationOfBenefit.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ADAUniversalToothDesignationSystem" ];
         fhir:Coding.code [ fhir:value "2" ]       ]     ]
  ];
  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/CoverageDental1" ]     ]
  ];
  fhir:ExplanationOfBenefit.item [
     fhir:index 0;
     fhir:ExplanationOfBenefit.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.item.informationSequence [
       fhir:value "6"^^xsd:positiveInteger;
       fhir:index 0     ], [
       fhir:value "7"^^xsd:positiveInteger;
       fhir:index 1     ], [
       fhir:value "9"^^xsd:positiveInteger;
       fhir:index 2     ], [
       fhir:value "10"^^xsd:positiveInteger;
       fhir:index 3     ], [
       fhir:value "11"^^xsd:positiveInteger;
       fhir:index 4     ];
     fhir:ExplanationOfBenefit.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://www.ada.org/cdt" ];
         fhir:Coding.code [ fhir:value "D0220" ];
         fhir:Coding.display [ fhir:value "Intraoral - periapical first radiographic image" ]       ]     ];
     fhir:ExplanationOfBenefit.item.servicedDate [ fhir:value "2021-10-28"^^xsd:date ];
     fhir:ExplanationOfBenefit.item.locationCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set" ];
         fhir:Coding.code [ fhir:value "11" ];
         fhir:Coding.display [ fhir:value "Office" ]       ]     ];
     fhir:ExplanationOfBenefit.item.bodySite [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ADAAreaOralCavitySystem" ];
         fhir:Coding.code [ fhir:value "10" ];
         fhir:Coding.display [ fhir:value "Upper right quadrant" ]       ]     ];
     fhir:ExplanationOfBenefit.item.subSite [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSurfaceCodes" ];
         fhir:Coding.code [ fhir:value "O" ]       ]     ], [
       fhir:index 1;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSurfaceCodes" ];
         fhir:Coding.code [ fhir:value "I" ]       ]     ];
     fhir:ExplanationOfBenefit.item.adjudication [
       fhir:index 0;
       fhir:ExplanationOfBenefit.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator" ];
           fhir:Coding.code [ fhir:value "benefitpaymentstatus" ]         ]       ];
       fhir:ExplanationOfBenefit.item.adjudication.reason [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus" ];
           fhir:Coding.code [ fhir:value "innetwork" ]         ]       ]     ], [
       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 "submitted" ]         ]       ];
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "150"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ]     ]
  ];
  fhir:ExplanationOfBenefit.adjudication [
     fhir:index 0;
     fhir:ExplanationOfBenefit.item.adjudication.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator" ];
         fhir:Coding.code [ fhir:value "renderingnetworkstatus" ]       ]     ];
     fhir:ExplanationOfBenefit.item.adjudication.reason [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus" ];
         fhir:Coding.code [ fhir:value "innetwork" ]       ]     ]
  ], [
     fhir:index 1;
     fhir:ExplanationOfBenefit.item.adjudication.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator" ];
         fhir:Coding.code [ fhir:value "benefitpaymentstatus" ]       ]     ];
     fhir:ExplanationOfBenefit.item.adjudication.reason [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus" ];
         fhir:Coding.code [ fhir:value "innetwork" ]       ]     ]
  ], [
     fhir:index 2;
     fhir:ExplanationOfBenefit.item.adjudication.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator" ];
         fhir:Coding.code [ fhir:value "billingnetworkstatus" ]       ]     ];
     fhir:ExplanationOfBenefit.item.adjudication.reason [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus" ];
         fhir:Coding.code [ fhir:value "innetwork" ]       ]     ]
  ];
  fhir:ExplanationOfBenefit.total [
     fhir:index 0;
     fhir:ExplanationOfBenefit.total.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:CodeableConcept.text [ fhir:value "Submitted Amount" ]     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "150"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ]
  ], [
     fhir:index 1;
     fhir:ExplanationOfBenefit.total.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:CodeableConcept.text [ fhir:value "Benefit Amount" ]     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "110"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ]
  ], [
     fhir:index 2;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
         fhir:Coding.code [ fhir:value "discount" ]       ];
       fhir:CodeableConcept.text [ fhir:value "Discount Amount" ]     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "40"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ]
  ], [
     fhir:index 3;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
         fhir:Coding.code [ fhir:value "paidtoprovider" ]       ];
       fhir:CodeableConcept.text [ fhir:value "Amount Paid to Provider" ]     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "100"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ]
  ].

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

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.