Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot Saudi Arabia flag

Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Advanced Authorization example #1 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

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

 a fhir:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "142298"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/advanced-authorization|0.3.0"^^xsd:anyURI ;
fhir:link <http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/advanced-authorization|0.3.0>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse 142298</b></p><a name=\"142298\"> </a><a name=\"hc142298\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-advanced-authorization.html\">Nphies Advanced Authorizationversion: null0.3.0)</a></p></div><p><b>Adjudication Outcome</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/adjudication-outcome approved}\">Approved</span></p><p><b>Advanced Auth Reason</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/advancedAuth-reason referral}\">Referral</span></p><p><b>Newborn</b>: false</p><p><b>Service Provider Extension</b>: <a href=\"Bundle-16b80922-b538-4ab3-0176-a80b33242163.html#http-//sni.com.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae\">Bundle: type = message; timestamp = 2024-12-02 19:36:29+0000</a></p><p><b>Referring Provider Extension</b>: Dr. Test Doctor outside npies (wave3)</p><blockquote><p><b>Supporting Info Extension</b></p><ul><li>http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-sequence: 1</li><li>http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-category: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-information-category info}\">Information</span></li><li>http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-valueString: Advanced authorization for providing mentioned services to the patient</li></ul></blockquote><blockquote><p><b>Diagnosis Extension</b></p><ul><li>http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-sequence: 1</li><li>http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-diagnosisCodeableConcept: <span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-am K01.1}\">K01.1</span></li><li>http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-type: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/diagnosis-type principal}\">Principal Diagnosis</span></li></ul></blockquote><blockquote><p><b>Diagnosis Extension</b></p><ul><li>http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-sequence: 2</li><li>http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-diagnosisCodeableConcept: <span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-am V49.4}\">V49.4</span></li><li>http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-type: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/diagnosis-type secondary}\">Secondary Diagnosis</span></li></ul></blockquote><p><b>identifier</b>: <code>http://sni.com.sa/identifiers/advanced-priorauth</code>/AdvAuth-300982300</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type oral}\">Oral</span></p><p><b>subType</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/claim-subtype op}\">OutPatient</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Bundle-16b80922-b538-4ab3-0176-a80b33242163.html#http-//sni.com.sa/Patient/123454186\">Bundle: type = message; timestamp = 2024-12-02 19:36:29+0000</a></p><p><b>created</b>: 2022-07-18</p><p><b>insurer</b>: <a href=\"Bundle-16b80922-b538-4ab3-0176-a80b33242163.html#http-//sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db\">Bundle: type = message; timestamp = 2024-12-02 19:36:29+0000</a></p><p><b>outcome</b>: Processing Complete</p><p><b>preAuthRef</b>: AdAuth-150123-1530</p><p><b>preAuthPeriod</b>: 2022-09-15 18:10:44+0000 --&gt; 2022-10-15 18:10:44+0000</p><blockquote><p><b>addItem</b></p><p><b>Maternity</b>: false</p><p><b>Adjudication Outcome</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/adjudication-outcome approved}\">Approved</span></p><p><b>Sequence Extension</b>: 1</p><p><b>Information Sequence Extension</b>: 1</p><p><b>Package Code</b>: false</p><p><b>productOrService</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/oral-health-op 658}\">The extraoral repair of a crown, bridge or splint.</span></p><p><b>quantity</b>: 1</p><p><b>bodySite</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/fdi-oral-region 25}\">UPPER LEFT; PERMANENT TEETH # 5</span></p><p><b>subSite</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/fdi-tooth-surface V}\">Ventral</span></p><p><b>noteNumber</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</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>100</td><td>Saudi riyal</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}\">CoPay</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>0</td><td>Saudi riyal</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/ksa-adjudication approved-quantity}\">Approved Quantity</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>1</td><td>Saudi riyal</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication tax}\">Tax</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>15</td><td>Saudi riyal</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</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>100</td><td>Saudi riyal</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</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>100</td><td>Saudi riyal</td></tr></table></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Number</b></td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Display</td><td>Process Note Text to give more general information or direction</td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>false</td><td><a href=\"Bundle-43c68545-8e37-4744-b8ea-9a1e3c1ada84.html#http-//sni.com.sa/Coverage/1333\">Bundle: type = message; timestamp = 2023-12-19 08:20:29+0000</a></td></tr></table></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/adjudication-outcome"^^xsd:anyURI ] ;
fhir:code [ fhir:v "approved" ]       ] )     ]
  ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-advancedAuth-reason"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/advancedAuth-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "referral" ]       ] )     ]
  ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn"^^xsd:anyURI ] ;
fhir:value [
a fhir:boolean ;
fhir:v false     ]
  ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-serviceProvider"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:link <http://sni.com.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae> ;
fhir:reference [ fhir:v "http://sni.com.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae" ]     ]
  ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-referringProvider"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:display [ fhir:v "Dr. Test Doctor outside npies (wave3)" ]     ]
  ] [
    ( fhir:extension [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-sequence"^^xsd:anyURI ] ;
fhir:value [
a fhir:positiveInt ;
fhir:v "1"^^xsd:positiveInteger       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-category"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-information-category"^^xsd:anyURI ] ;
fhir:code [ fhir:v "info" ]         ] )       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-valueString"^^xsd:anyURI ] ;
fhir:value [
a fhir:string ;
fhir:v "Advanced authorization for providing mentioned services to the patient"       ]     ] ) ;
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo"^^xsd:anyURI ]
  ] [
    ( fhir:extension [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-sequence"^^xsd:anyURI ] ;
fhir:value [
a fhir:positiveInt ;
fhir:v "1"^^xsd:positiveInteger       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-diagnosisCodeableConcept"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10-am"^^xsd:anyURI ] ;
fhir:code [ fhir:v "K01.1" ]         ] )       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-type"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/diagnosis-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "principal" ]         ] )       ]     ] ) ;
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis"^^xsd:anyURI ]
  ] [
    ( fhir:extension [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-sequence"^^xsd:anyURI ] ;
fhir:value [
a fhir:positiveInt ;
fhir:v "2"^^xsd:positiveInteger       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-diagnosisCodeableConcept"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10-am"^^xsd:anyURI ] ;
fhir:code [ fhir:v "V49.4" ]         ] )       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-type"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/diagnosis-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "secondary" ]         ] )       ]     ] ) ;
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis"^^xsd:anyURI ]
  ] ) ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://sni.com.sa/identifiers/advanced-priorauth"^^xsd:anyURI ] ;
fhir:value [ fhir:v "AdvAuth-300982300" ]
  ] ) ; # 
  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 "oral" ]     ] )
  ] ; # 
  fhir:subType [
    ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/claim-subtype"^^xsd:anyURI ] ;
fhir:code [ fhir:v "op" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "preauthorization"] ; # 
  fhir:patient [
fhir:link <http://sni.com.sa/Patient/123454186> ;
fhir:reference [ fhir:v "http://sni.com.sa/Patient/123454186" ]
  ] ; # 
  fhir:created [ fhir:v "2022-07-18"^^xsd:date] ; # 
  fhir:insurer [
fhir:link <http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db> ;
fhir:reference [ fhir:v "http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:preAuthRef [ fhir:v "AdAuth-150123-1530"] ; # 
  fhir:preAuthPeriod [
fhir:start [ fhir:v "2022-09-15T18:10:44.732+00:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "2022-10-15T18:10:44.732+00:00"^^xsd:dateTime ]
  ] ; # 
  fhir:addItem ( [
    ( fhir:extension [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity"^^xsd:anyURI ] ;
fhir:value [
a fhir:boolean ;
fhir:v false       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/adjudication-outcome"^^xsd:anyURI ] ;
fhir:code [ fhir:v "approved" ]         ] )       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-sequence"^^xsd:anyURI ] ;
fhir:value [
a fhir:positiveInt ;
fhir:v "1"^^xsd:positiveInteger       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-informationSequence"^^xsd:anyURI ] ;
fhir:value [
a fhir:positiveInt ;
fhir:v "1"^^xsd:positiveInteger       ]     ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package"^^xsd:anyURI ] ;
fhir:value [
a fhir:boolean ;
fhir:v false       ]     ] ) ;
fhir:productOrService [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/oral-health-op"^^xsd:anyURI ] ;
fhir:code [ fhir:v "658" ]       ] )     ] ;
fhir:quantity [
fhir:value [ fhir:v "1"^^xsd:decimal ]     ] ;
fhir:bodySite [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/fdi-oral-region"^^xsd:anyURI ] ;
fhir:code [ fhir:v "25" ]       ] )     ] ;
    ( fhir:subSite [
      ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/fdi-tooth-surface"^^xsd:anyURI ] ;
fhir:code [ fhir:v "V" ]       ] )     ] ) ;
    ( fhir:noteNumber [ fhir:v "1"^^xsd:positiveInteger ] ) ;
    ( fhir:adjudication [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "eligible" ]         ] )       ] ;
fhir:amount [
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]       ]     ] [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "copay" ]         ] )       ] ;
fhir:amount [
fhir:value [ fhir:v "0"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]       ]     ] [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/ksa-adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "approved-quantity" ]         ] )       ] ;
fhir:amount [
fhir:value [ fhir:v "1"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]       ]     ] [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "tax" ]         ] )       ] ;
fhir:amount [
fhir:value [ fhir:v "15"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]       ]     ] [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "benefit" ]         ] )       ] ;
fhir:amount [
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]       ]     ] )
  ] ) ; # 
  fhir:total ( [
fhir:category [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "benefit" ]       ] )     ] ;
fhir:amount [
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]     ]
  ] ) ; # 
  fhir:processNote ( [
fhir:number [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:type [ fhir:v "display" ] ;
fhir:text [ fhir:v "Process Note Text to give more general information or direction" ]
  ] ) ; # 
  fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v false ] ;
fhir:coverage [
fhir:link <http://sni.com.sa/Coverage/1333> ;
fhir:reference [ fhir:v "http://sni.com.sa/Coverage/1333" ]     ]
  ] ) . #