Site Eligibility - TTL Representation - Healthcare Financial Services IG Edition 1 v0.3.0

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
: Site Eligibility - TTL Representation

Active as of 2025-06-23
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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:CodeSystem ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "siteEligibility"] ; # 
  fhir:meta [
fhir:versionId [ fhir:v "2" ] ;
fhir:lastUpdated [ fhir:v "2024-08-15T14:37:19.259+03:00"^^xsd:dateTime ]
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem siteEligibility</b></p><a name=\"siteEligibility\"> </a><a name=\"hcsiteEligibility\"> </a><a name=\"siteEligibility-en-US\"> </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\">version: 2; Last updated: 2024-08-15 14:37:19+0300</p></div><p>This case-sensitive code system <code>http://nphies.sa/terminology/CodeSystem/siteEligibility</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td><td><b>Arabic (ar)</b></td></tr><tr><td style=\"white-space:nowrap\">eligible<a name=\"siteEligibility-eligible\"> </a></td><td>Eligible</td><td>Code to be used when the patient is eligibile</td><td>مؤهل</td></tr><tr><td style=\"white-space:nowrap\">not-active<a name=\"siteEligibility-not-active\"> </a></td><td>Member's insurance policy is not active</td><td>When HCP sends an eligibility request for an expired or canceled member’s policy on the eligibility service date.</td><td>بوليصة التأمين لهذا العضو غير سارية</td></tr><tr><td style=\"white-space:nowrap\">not-covered<a name=\"siteEligibility-not-covered\"> </a></td><td>Policy does not cover the requested services</td><td>When HCP sends an eligibility request mentioning a department that offers services out of patient policy coverage.</td><td>البوليصة لاتغطي الخدمات المطلوبة</td></tr><tr><td style=\"white-space:nowrap\">out-network<a name=\"siteEligibility-out-network\"> </a></td><td>Provider outside member Network</td><td>Facility is outside the member covered policy network.</td><td>مقدم الخدمة لا ينتمي إلي شبكة التأمين</td></tr><tr><td style=\"white-space:nowrap\">provider-contract-suspended<a name=\"siteEligibility-provider-contract-suspended\"> </a></td><td>Provider contract is suspended</td><td>Provider can be suspended for any reason (regulation, contractual, legal… etc.)</td><td>التعاقد مع مقدم الخدمة معلق</td></tr><tr><td style=\"white-space:nowrap\">coverage-suspended<a name=\"siteEligibility-coverage-suspended\"> </a></td><td>Patient coverage is suspended</td><td>Insurance coverage can be suspended for any reason (regulation, financial, legal, etc.)</td><td>تغطية هذا المريض معلقة</td></tr><tr><td style=\"white-space:nowrap\">not-direct billing<a name=\"siteEligibility-not-directbilling\"> </a></td><td>Patient is not covered on direct billing basis</td><td>When HCP sends an eligibility request for insured member who is covered on patient reimbursement basis, so even the member has an active policy, but he will pay the medical fees out of his pocket and reimburse the claims. (e.g.: members covered under visit visa insurance policy)</td><td>المريض غير مغطى على أساس السداد المباشر</td></tr><tr><td style=\"white-space:nowrap\">limit-exhausted<a name=\"siteEligibility-limit-exhausted\"> </a></td><td>Patient policy/benefit limit is exhausted</td><td>When member consumed the annual or benefit limit, benefit limit can be indicated from the department in the eligibility request or from the provider type, e.g. request from received from optical shop for a member consumed the optical benefit.</td><td>الحد الأقصى لهذه الميزة التأمينية للمريض تم استهلاكه</td></tr></table></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:url [ fhir:v "http://nphies.sa/terminology/CodeSystem/siteEligibility"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "0.3.0"] ; # 
  fhir:name [ fhir:v "SiteEligibility"] ; # 
  fhir:title [ fhir:v "Site Eligibility"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v false] ; # 
  fhir:date [ fhir:v "2025-06-23T22:09:21+03:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "HL7 Saudi Arabia"] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "HL7 Saudi Arabia" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://test-project.org/test-publisher" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "This code set includes codes indicating the eligibility of the coverage at the identified site."] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SA" ] ;
fhir:display [ fhir:v "Saudi Arabia" ]     ] )
  ] ) ; # 
  fhir:copyright [ fhir:v "nphies 2020+ (https://nphies.sa)"] ; # 
  fhir:caseSensitive [ fhir:v true] ; # 
  fhir:compositional [ fhir:v false] ; # 
  fhir:versionNeeded [ fhir:v false] ; # 
  fhir:content [ fhir:v "complete"] ; # 
  fhir:concept ( [
fhir:code [ fhir:v "eligible" ] ;
fhir:display [ fhir:v "Eligible" ] ;
fhir:definition [ fhir:v "Code to be used when the patient is eligibile" ] ;
    ( fhir:designation [
fhir:language [ fhir:v "ar" ] ;
fhir:value [ fhir:v "مؤهل" ]     ] )
  ] [
fhir:code [ fhir:v "not-active" ] ;
fhir:display [ fhir:v "Member's insurance policy is not active" ] ;
fhir:definition [ fhir:v "When HCP sends an eligibility request for an expired or canceled member’s policy on the eligibility service date." ] ;
    ( fhir:designation [
fhir:language [ fhir:v "ar" ] ;
fhir:value [ fhir:v "بوليصة التأمين لهذا العضو غير سارية" ]     ] )
  ] [
fhir:code [ fhir:v "not-covered" ] ;
fhir:display [ fhir:v "Policy does not cover the requested services" ] ;
fhir:definition [ fhir:v "When HCP sends an eligibility request mentioning a department that offers services out of patient policy coverage." ] ;
    ( fhir:designation [
fhir:language [ fhir:v "ar" ] ;
fhir:value [ fhir:v "البوليصة لاتغطي الخدمات المطلوبة" ]     ] )
  ] [
fhir:code [ fhir:v "out-network" ] ;
fhir:display [ fhir:v "Provider outside member Network" ] ;
fhir:definition [ fhir:v "Facility is outside the member covered policy network." ] ;
    ( fhir:designation [
fhir:language [ fhir:v "ar" ] ;
fhir:value [ fhir:v "مقدم الخدمة لا ينتمي إلي شبكة التأمين" ]     ] )
  ] [
fhir:code [ fhir:v "provider-contract-suspended" ] ;
fhir:display [ fhir:v "Provider contract is suspended" ] ;
fhir:definition [ fhir:v "Provider can be suspended for any reason (regulation, contractual, legal… etc.)" ] ;
    ( fhir:designation [
fhir:language [ fhir:v "ar" ] ;
fhir:value [ fhir:v "التعاقد مع مقدم الخدمة معلق" ]     ] )
  ] [
fhir:code [ fhir:v "coverage-suspended" ] ;
fhir:display [ fhir:v "Patient coverage is suspended" ] ;
fhir:definition [ fhir:v "Insurance coverage can be suspended for any reason (regulation, financial, legal, etc.)" ] ;
    ( fhir:designation [
fhir:language [ fhir:v "ar" ] ;
fhir:value [ fhir:v "تغطية هذا المريض معلقة" ]     ] )
  ] [
fhir:code [ fhir:v "not-direct billing" ] ;
fhir:display [ fhir:v "Patient is not covered on direct billing basis" ] ;
fhir:definition [ fhir:v "When HCP sends an eligibility request for insured member who is covered on patient reimbursement basis, so even the member has an active policy, but he will pay the medical fees out of his pocket and reimburse the claims. (e.g.: members covered under visit visa insurance policy)" ] ;
    ( fhir:designation [
fhir:language [ fhir:v "ar" ] ;
fhir:value [ fhir:v "المريض غير مغطى على أساس السداد المباشر" ]     ] )
  ] [
fhir:code [ fhir:v "limit-exhausted" ] ;
fhir:display [ fhir:v "Patient policy/benefit limit is exhausted" ] ;
fhir:definition [ fhir:v "When member consumed the annual or benefit limit, benefit limit can be indicated from the department in the eligibility request or from the provider type, e.g. request from received from optical shop for a member consumed the optical benefit." ] ;
    ( fhir:designation [
fhir:language [ fhir:v "ar" ] ;
fhir:value [ fhir:v "الحد الأقصى لهذه الميزة التأمينية للمريض تم استهلاكه" ]     ] )
  ] ) . #