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

: Authorization Oral Response #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 "618042"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|0.3.0"^^xsd:anyURI ;
fhir:link <http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|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 618042</b></p><a name=\"618042\"> </a><a name=\"hc618042\"> </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-prior-auth-response.html\">Nphies Authorization Responseversion: 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>Transfer Authorization Number</b>: GHD517</p><p><b>Transfer Authorization Period</b>: 2021-10-10 --&gt; 2021-10-12</p><p><b>Transfer Authorization Provider</b>: <a href=\"Organization-bff3aa1fbd3648619ac082357bf135ab.html\">Organization Test Provider 2</a></p><p><b>identifier</b>: <code>http://sni.com.sa/identifiers/claimresponse</code>/resp_618044</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=\"Patient-453.html\">Sara Abbas Female, DoB: 1989-03-13 ( Permanent Resident Card Number: 2000000003)</a></p><p><b>created</b>: 2023-12-05</p><p><b>insurer</b>: <a href=\"Organization-bff3aa1fbd3648619ac082357bf135db.html\">Organization Saudi National Insurance</a></p><p><b>requestor</b>: <a href=\"Organization-215.html\">Organization Saudi Dental Clinic</a></p><p><b>request</b>: Identifier: <code>http://saudidentalclinic.com.sa/identifiers/authorization</code>/req_293093</p><p><b>outcome</b>: Processing Complete</p><p><b>preAuthRef</b>: PLJ9147</p><p><b>preAuthPeriod</b>: 2021-10-10 --&gt; 2021-10-12</p><p><b>payeeType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></p><blockquote><p><b>item</b></p><p><b>Adjudication Outcome</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/adjudication-outcome approved}\">Approved</span></p><p><b>itemSequence</b>: 1</p><p><b>noteNumber</b>: 1</p><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><p><b>value</b>: 1</p></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>0</td><td>Saudi riyal</td></tr></table></blockquote></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>Print (Form)</td><td>Referral to Test Provider 2, authorization #GHD517, for Root Canal</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>true</td><td><a href=\"Coverage-1985.html\">Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000003; status = active; type = extended healthcare; relationship = Spouse; network = Golden C</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-transferAuthorizationNumber"^^xsd:anyURI ] ;
fhir:value [
a fhir:string ;
fhir:v "GHD517"     ]
  ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationPeriod"^^xsd:anyURI ] ;
fhir:value [
a fhir:Period ;
fhir:start [ fhir:v "2021-10-10"^^xsd:date ] ;
fhir:end [ fhir:v "2021-10-12"^^xsd:date ]     ]
  ] [
fhir:url [ fhir:v "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationProvider"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:reference [ fhir:v "Organization/bff3aa1fbd3648619ac082357bf135ab" ]     ]
  ] ) ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "http://sni.com.sa/identifiers/claimresponse"^^xsd:anyURI ] ;
fhir:value [ fhir:v "resp_618044" ]
  ] ) ; # 
  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:reference [ fhir:v "Patient/453" ]
  ] ; # 
  fhir:created [ fhir:v "2023-12-05"^^xsd:date] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/bff3aa1fbd3648619ac082357bf135db" ]
  ] ; # 
  fhir:requestor [
fhir:reference [ fhir:v "Organization/215" ]
  ] ; # 
  fhir:request [
fhir:identifier [
fhir:system [ fhir:v "http://saudidentalclinic.com.sa/identifiers/authorization"^^xsd:anyURI ] ;
fhir:value [ fhir:v "req_293093" ]     ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:preAuthRef [ fhir:v "PLJ9147"] ; # 
  fhir:preAuthPeriod [
fhir:start [ fhir:v "2021-10-10"^^xsd:date ] ;
fhir:end [ fhir:v "2021-10-12"^^xsd:date ]
  ] ; # 
  fhir:payeeType [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ;
fhir:code [ fhir:v "provider" ]     ] )
  ] ; # 
  fhir:item ( [
    ( 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:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    ( fhir:noteNumber [ fhir:v "1"^^xsd:positiveInteger ] ) ;
    ( fhir:adjudication [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://nphies.sa/terminology/CodeSystem/ksa-adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "approved-quantity" ]         ] )       ] ;
fhir:value [ fhir:v "1"^^xsd:decimal ]     ] [
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 "0"^^xsd:decimal ] ;
fhir:currency [ fhir:v "SAR" ]       ]     ] )
  ] ) ; # 
  fhir:processNote ( [
fhir:number [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:type [ fhir:v "print" ] ;
fhir:text [ fhir:v "Referral to Test Provider 2, authorization #GHD517, for Root Canal" ]
  ] ) ; # 
  fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v true ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/1985" ]     ]
  ] ) . #