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• Narrative Content

: PdexPriorAuth - 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 "PDexPriorAuth1"];
  fhir:Resource.meta [
     fhir:Meta.lastUpdated [ fhir:value "2021-10-12T09:14:11+00:00"^^xsd:dateTime ];
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-priorauthorization|2.0.0";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-priorauthorization|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</b></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 \"PDexPriorAuth1\" Updated \"2021-10-12 09:14:11+0000\"  (Language \"en-US\") </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-pdex-priorauthorization.html\">PDex Prior Authorization (version 2.0.0-ballot)</a></p></div><p><b>identifier</b>: id: PA123412341234123412341234</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/3.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#institutional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"Patient-1.html\">Patient/1</a> \" APPLESEED\"</p><p><b>billablePeriod</b>: 2021-10-01 --&gt; 2021-10-31</p><p><b>created</b>: 2021-09-20 12:00:00+0000</p><p><b>insurer</b>: <a href=\"Organization-Payer1.html\">Organization/Payer1: Example Health Plan</a> \"Payer 1\"</p><p><b>provider</b>: <a href=\"Organization-Payer2.html\">Organization/Payer2: Another Example Health Plan</a> \"Payer 2\"</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><p><b>fundsReserveRequested</b>: Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-fundsreserve.html\">Funds Reservation Codes</a>#provider)</span></p><p><b>fundsReserve</b>: None <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-fundsreserve.html\">Funds Reservation Codes</a>#none)</span></p><h3>Relateds</h3><table class=\"grid\"><tr><td>-</td><td><b>Relationship</b></td><td><b>Reference</b></td></tr><tr><td>*</td><td>Associated Claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-ex-relatedclaimrelationship.html\">Example Related Claim Relationship Codes</a>#associated)</span></td><td>id: XCLM1001</td></tr></table><p><b>outcome</b>: queued</p><p><b>preAuthRefPeriod</b>: 2021-10-01 --&gt; 2021-10-31</p><h3>CareTeams</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Responsible</b></td></tr><tr><td>*</td><td>1</td><td><a href=\"Organization-Payer1.html\">Organization/Payer1</a> \"Payer 1\"</td><td>true</td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td>*</td><td>1</td><td>Chronic pain syndrome <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#G89.4)</span></td><td>Principal Diagnosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-ex-diagnosistype.html\">Example Diagnosis Type Codes</a>#principal)</span></td></tr></table><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-Coverage1.html\">Coverage/Coverage1</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (service-type-codes#3)</span></p><p><b>productOrService</b>: 99202 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT&reg;)</a>#99202)</span></p><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/3.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p></blockquote></blockquote></div>"
  ];
  fhir:ExplanationOfBenefit.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "https://www.exampleplan.com/fhir/EOBIdentifier" ];
     fhir:Identifier.value [ fhir:value "PA123412341234123412341234" ]
  ];
  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 "institutional" ]     ];
     fhir:CodeableConcept.text [ fhir:value "Institutional" ]
  ];
  fhir:ExplanationOfBenefit.use [ fhir:value "preauthorization"];
  fhir:ExplanationOfBenefit.patient [
     fhir:Reference.reference [ fhir:value "Patient/1" ]
  ];
  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 "2021-09-20T00:00:00+00:00"^^xsd:dateTime];
  fhir:ExplanationOfBenefit.insurer [
     fhir:Reference.reference [ fhir:value "Organization/Payer1" ];
     fhir:Reference.display [ fhir:value "Example Health Plan" ]
  ];
  fhir:ExplanationOfBenefit.provider [
     fhir:Reference.reference [ fhir:value "Organization/Payer2" ];
     fhir:Reference.display [ fhir:value "Another Example Health Plan" ]
  ];
  fhir:ExplanationOfBenefit.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
       fhir:Coding.code [ fhir:value "normal" ];
       fhir:Coding.display [ fhir:value "Normal" ]     ]
  ];
  fhir:ExplanationOfBenefit.fundsReserveRequested [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/fundsreserve" ];
       fhir:Coding.code [ fhir:value "provider" ];
       fhir:Coding.display [ fhir:value "Provider" ]     ]
  ];
  fhir:ExplanationOfBenefit.fundsReserve [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/fundsreserve" ];
       fhir:Coding.code [ fhir:value "none" ];
       fhir:Coding.display [ fhir:value "None" ]     ]
  ];
  fhir:ExplanationOfBenefit.related [
     fhir:index 0;
     fhir:ExplanationOfBenefit.related.relationship [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship" ];
         fhir:Coding.code [ fhir:value "associated" ];
         fhir:Coding.display [ fhir:value "Associated Claim" ]       ]     ];
     fhir:ExplanationOfBenefit.related.reference [
       fhir:Identifier.value [ fhir:value "XCLM1001" ]     ]
  ];
  fhir:ExplanationOfBenefit.outcome [ fhir:value "queued"];
  fhir:ExplanationOfBenefit.preAuthRefPeriod [
     fhir:index 0;
     fhir:Period.start [ fhir:value "2021-10-01"^^xsd:date ];
     fhir:Period.end [ fhir:value "2021-10-31"^^xsd:date ]
  ];
  fhir:ExplanationOfBenefit.careTeam [
     fhir:index 0;
     fhir:ExplanationOfBenefit.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.careTeam.provider [
       fhir:Reference.reference [ fhir:value "Organization/Payer1" ]     ];
     fhir:ExplanationOfBenefit.careTeam.responsible [ fhir:value "true"^^xsd:boolean ]
  ];
  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 "G89.4" ]       ]     ];
     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: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.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "https://x12.org/codes/service-type-codes" ];
         fhir:Coding.code [ fhir:value "3" ];
         fhir:Coding.display [ fhir:value "Consultation" ]       ]     ];
     fhir:ExplanationOfBenefit.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://www.ama-assn.org/go/cpt" ];
         fhir:Coding.code [ fhir:value "99202" ]       ]     ];
     fhir:ExplanationOfBenefit.item.adjudication [
       fhir:index 0;
       fhir:Element.id [ fhir:value "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:Coding.display [ fhir:value "Submitted Amount" ]         ]       ];
       fhir:ExplanationOfBenefit.item.adjudication.amount [
         fhir:Money.value [ fhir:value "300.99"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ]     ]
  ].

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

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