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

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

<http://hl7.org/fhir/us/davinci-pct/ExplanationOfBenefit/PCT-AEOB-1> a fhir:ExplanationOfBenefit ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "PCT-AEOB-1"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob"^^xsd:anyURI ;
       fhir:link <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob>
     ] )
  ] ; # 
  fhir:text [
     fhir:status [ fhir:v "extensions" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name=\"PCT-AEOB-1\"> </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;PCT-AEOB-1&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-aeob.html\">PCT Advanced EOB</a></p></div><p><b>GFE Reference</b>: <a href=\"Bundle-PCT-GFE-Bundle-Inst-1.html\">Bundle/PCT-GFE-Bundle-Inst-1</a></p><p><b>Service Description</b>: Example service</p><p><b>In Network Provider Options Link</b>: <a href=\"http://example.com/out-of-network.html\">http://example.com/out-of-network.html</a></p><p><b>identifier</b>: Unique Claim ID: ?ngen-9?</p><p><b>status</b>: active</p><p><b>type</b>: Institutional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#institutional)</span></p><p><b>use</b>: predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Patient/patient1001</a> &quot; BETTERHALF&quot;</p><p><b>created</b>: 2021-10-12</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization/org1001</a> &quot;Umbrella Insurance Company&quot;</p><p><b>provider</b>: <a href=\"Organization-org1002.html\">Organization/org1002</a> &quot;Boston Radiology Center&quot;</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><p><b>claim</b>: <span>id: 59688475-2324-3242-23473847</span></p><p><b>outcome</b>: complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage/coverage1001</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>revenue</b>: Magnetic Resonance Technology (MRT) - Brain/brain stem <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-AHANUBCRevenueCodes.html\">AHA NUBC Revenue Codes</a>#0611)</span></p><p><b>productOrService</b>: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT®)</a>#70551)</span></p><p><b>modifier</b>: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT®)</a>#70551)</span></p><p><b>serviced</b>: 2022-01-01</p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>USD</td></tr></table><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>Medical Management <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PCTAdjudicationCategoryCS.html\">PCT Adjudication Category CodeSystem</a>#medicalmanagement)</span></td></tr></table></blockquote><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>Medical Management <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PCTAdjudicationCategoryCS.html\">PCT Adjudication Category CodeSystem</a>#medicalmanagement)</span></td></tr><tr><td style=\"display: none\">*</td><td> </td><td>Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></td></tr><tr><td style=\"display: none\">*</td><td> </td><td>Member Liability <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PCTAdjudicationCategoryCS.html\">PCT Adjudication Category CodeSystem</a>#memberliability)</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/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>USD</td></tr></table></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>processNote disclaimer text</td></tr></table><p><b>benefitPeriod</b>: 2022-01-01 --&gt; 2023-01-01</p><blockquote><p><b>benefitBalance</b></p><p><b>category</b>: Medical Care <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-X12ServiceTypeCodes.html\">X12 Service Type Codes</a>#1)</span></p><p><b>unit</b>: Individual <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-benefit-unit.html\">Unit Type Codes</a>#individual)</span></p><p><b>term</b>: Annual <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-benefit-term.html\">Benefit Term Codes</a>#annual)</span></p><h3>Financials</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>Allowed <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-PCTFinancialType.html\">PCT Financial Type Code System</a>#allowed)</span></td><td><span title=\"US Dollar\">US$1.00</span> (USD)</td><td><span title=\"US Dollar\">US$1.00</span> (USD)</td></tr></table></blockquote></div>"
  ] ; # 
  fhir:extension ( [
     fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference"^^xsd:anyURI ] ;
     fhir:value [
       a fhir:Reference ;
       fhir:link <http://hl7.org/fhir/us/davinci-pct/Bundle/PCT-GFE-Bundle-Inst-1> ;
       fhir:reference [ fhir:v "Bundle/PCT-GFE-Bundle-Inst-1" ]
     ]
  ] [
     fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "Example service" ]
  ] [
     fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "http://example.com/out-of-network.html"^^xsd:anyURI ]
  ] ) ; # 
  fhir:identifier ( [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "uc" ] ;
         fhir:display [ fhir:v "Unique Claim ID" ]
       ] )
     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "institutional" ] ;
       fhir:display [ fhir:v "Institutional" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "predetermination"] ; # 
  fhir:patient [
     fhir:link <http://hl7.org/fhir/us/davinci-pct/Patient/patient1001> ;
     fhir:reference [ fhir:v "Patient/patient1001" ]
  ] ; # 
  fhir:created [ fhir:v "2021-10-12"^^xsd:date] ; # 
  fhir:insurer [
     fhir:link <http://hl7.org/fhir/us/davinci-pct/Organization/org1001> ;
     fhir:reference [ fhir:v "Organization/org1001" ]
  ] ; # 
  fhir:provider [
     fhir:link <http://hl7.org/fhir/us/davinci-pct/Organization/org1002> ;
     fhir:reference [ fhir:v "Organization/org1002" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "normal" ]
     ] )
  ] ; # 
  fhir:claim [
     fhir:identifier [
       fhir:system [ fhir:v "http://example.com/identifiers/bundle"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "59688475-2324-3242-23473847" ]
     ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:insurance ( [
     fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
     fhir:coverage [
       fhir:link <http://hl7.org/fhir/us/davinci-pct/Coverage/coverage1001> ;
       fhir:reference [ fhir:v "Coverage/coverage1001" ]
     ]
  ] ) ; # 
  fhir:item ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:revenue [
       fhir:coding ( [
         fhir:system [ fhir:v "https://www.nubc.org/CodeSystem/RevenueCodes"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "0611" ] ;
         fhir:display [ fhir:v "Magnetic Resonance Technology (MRT) - Brain/brain stem" ]
       ] )
     ] ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [ fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "70551" ] ;
         fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ]
       ] )
     ] ;
     fhir:modifier ( [
       fhir:coding ( [
         fhir:system [ fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "70551" ] ;
         fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ]
       ] )
     ] ) ;
     fhir:serviced [ fhir:v "2022-01-01"^^xsd:date ] ;
     fhir:net [
       fhir:value [ fhir:v "200"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:adjudication ( [
       fhir:extension ( [
         fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"^^xsd:anyURI ] ;
         fhir:value [
           a fhir:CodeableConcept ;
           fhir:coding ( [
             fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSubjectToMedicalMgmtReasonCS"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "concurrent-review" ] ;
             fhir:display [ fhir:v "Concurrent Review" ]
           ] )
         ]
       ] ) ;
       fhir:category [
         fhir:coding ( [
           fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "medicalmanagement" ] ;
           fhir:display [ fhir:v "Medical Management" ]
         ] )
       ]
     ] )
  ] ) ; # 
  fhir:adjudication ( [
     fhir:extension ( [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"^^xsd:anyURI ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSubjectToMedicalMgmtReasonCS"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "concurrent-review" ] ;
           fhir:display [ fhir:v "Concurrent Review" ]
         ] )
       ]
     ] ) ;
     fhir:category [
       fhir:coding ( [
         fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "medicalmanagement" ] ;
         fhir:display [ fhir:v "Medical Management" ]
       ] )
     ]
  ] [
     fhir:category [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "submitted" ] ;
         fhir:display [ fhir:v "Submitted Amount" ]
       ] )
     ]
  ] [
     fhir:category [
       fhir:coding ( [
         fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "memberliability" ] ;
         fhir:display [ fhir:v "Member Liability" ]
       ] )
     ]
  ] ) ; # 
  fhir:total ( [
     fhir:category [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "submitted" ] ;
         fhir:display [ fhir:v "Submitted Amount" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v "200"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] ) ; # 
  fhir:processNote ( [
     fhir:extension ( [
       fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass"^^xsd:anyURI ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAEOBProcessNoteCS"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "disclaimer" ] ;
           fhir:display [ fhir:v "Disclaimer" ]
         ] )
       ]
     ] ) ;
     fhir:text [ fhir:v "processNote disclaimer text" ]
  ] ) ; # 
  fhir:benefitPeriod [
     fhir:start [ fhir:v "2022-01-01"^^xsd:date ] ;
     fhir:end [ fhir:v "2023-01-01"^^xsd:date ]
  ] ; # 
  fhir:benefitBalance ( [
     fhir:category [
       fhir:coding ( [
         fhir:system [ fhir:v "https://x12.org/codes/service-type-codes"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "1" ] ;
         fhir:display [ fhir:v "Medical Care" ]
       ] )
     ] ;
     fhir:unit [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "individual" ]
       ] )
     ] ;
     fhir:term [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "annual" ]
       ] )
     ] ;
     fhir:financial ( [
       fhir:extension ( [
         fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit"^^xsd:anyURI ] ;
         fhir:value [
           a fhir:Money ;
           fhir:value [ fhir:v "0"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ]
       ] ) ;
       fhir:type [
         fhir:coding ( [
           fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "allowed" ]
         ] )
       ] ;
       fhir:allowed [
         a fhir:Money ;
         fhir:value [ fhir:v "1"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:used [
         a fhir:Money ;
         fhir:value [ fhir:v "1"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ]
     ] )
  ] ) . # 

<http://hl7.org/fhir/us/davinci-pct/Bundle/PCT-GFE-Bundle-Inst-1> a fhir:us .

<http://hl7.org/fhir/us/davinci-pct/Patient/patient1001> a fhir:us .

<http://hl7.org/fhir/us/davinci-pct/Organization/org1001> a fhir:us .

<http://hl7.org/fhir/us/davinci-pct/Organization/org1002> a fhir:us .

<http://hl7.org/fhir/us/davinci-pct/Coverage/coverage1001> a fhir:us .

# -------------------------------------------------------------------------------------