haau3 FHIR Implementation Guide (HFIG)
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: haau3 Explanation of Benefit — an outpatient claim - 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 -------------------------------------------------------------------

<http://hl7.org/fhir/ExplanationOfBenefit/haau3-explanation-of-benefit-outpatient> a fhir:ExplanationOfBenefit ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "haau3-explanation-of-benefit-outpatient"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "https://haau3.com/fhir/StructureDefinition/haau3-explanation-of-benefit" ;
       fhir:index 0 ;
       fhir:link <https://haau3.com/fhir/StructureDefinition/haau3-explanation-of-benefit>
     ], [
       fhir:value "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional" ;
       fhir:index 1 ;
       fhir:link <http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional>
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit haau3-explanation-of-benefit-outpatient</b></p><a name=\"haau3-explanation-of-benefit-outpatient\"> </a><a name=\"hchaau3-explanation-of-benefit-outpatient\"> </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\">Profiles: <a href=\"StructureDefinition-haau3-explanation-of-benefit.html\">haau3 Explanation of Benefit</a>, <code>http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional</code></p></div><p><b>identifier</b>: <code>https://haau3.com/fhir/NamingSystem/source-resource-id</code>/ExplanationOfBenefit/example-source-record, <code>https://bluebutton.cms.gov/resources/variables/clm_id</code>/EXAMPLE-CLM-0001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-haau3-patient.html\">Derrick Lin  Male, DoB: 1965-04-12 ( https://haau3.com/fhir/NamingSystem/haau3-patient-id#Haau3PatientId#example-haau3-patient (use: usual, ))</a></p><p><b>created</b>: 2026-02-04</p><p><b>insurer</b>: Identifier: <a href=\"http://terminology.hl7.org/7.3.0/NamingSystem-USEIN.html\" title=\"An Employer Identification Number (EIN) is also known as a Federal Tax Identification Number, and is used to identify a business entity.\">United States Employer Identification Number</a>/EXAMPLE-INSURER</p><p><b>provider</b>: <a href=\"#hchaau3-explanation-of-benefit-outpatient/ExampleClaimProviderOrganization\">Organization Valley Outpatient Center</a></p><p><b>outcome</b>: Processing 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-haau3-coverage-two-payors.html\">Coverage: extension = -&gt;display: string (PrimitiveType/Coverage.extension[0].value[x].display): element = string -&gt; display=string[Northgate Supplemental Benefits]; identifier = https://haau3.com/fhir/NamingSystem/source-resource-id#Coverage/example-source-record; status = active; subscriberId = VM-88214; relationship = 01</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>ProductOrService</b></td><td><b>Serviced[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{https://bluebutton.cms.gov/resources/codesystem/hcpcs EXAMPLE01}\">EXAMPLE01</span></td><td>2026-02-01</td></tr></table><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:\">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>412.5</td><td>United States dollar</td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Organization #ExampleClaimProviderOrganization</b></p><a name=\"haau3-explanation-of-benefit-outpatient/ExampleClaimProviderOrganization\"> </a><a name=\"hchaau3-explanation-of-benefit-outpatient/ExampleClaimProviderOrganization\"> </a><p><b>active</b>: true</p><p><b>name</b>: Valley Outpatient Center</p></blockquote></div>"
  ] ;
  fhir:DomainResource.contained [
     a fhir:Organization ;
     fhir:index 0 ;
     fhir:Resource.id [ fhir:value "ExampleClaimProviderOrganization" ] ;
     fhir:Organization.active [ fhir:value "true"^^xsd:boolean ] ;
     fhir:Organization.name [ fhir:value "Valley Outpatient Center" ]
  ] ;
  fhir:ExplanationOfBenefit.identifier [
     fhir:index 0 ;
     fhir:Identifier.system [ fhir:value "https://haau3.com/fhir/NamingSystem/source-resource-id" ] ;
     fhir:Identifier.value [ fhir:value "ExplanationOfBenefit/example-source-record" ]
  ], [
     fhir:index 1 ;
     fhir:Identifier.system [ fhir:value "https://bluebutton.cms.gov/resources/variables/clm_id" ] ;
     fhir:Identifier.value [ fhir:value "EXAMPLE-CLM-0001" ]
  ] ;
  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:ExplanationOfBenefit.use [ fhir:value "claim"] ;
  fhir:ExplanationOfBenefit.patient [
     fhir:link <http://hl7.org/fhir/Patient/haau3-patient> ;
     fhir:Reference.reference [ fhir:value "Patient/haau3-patient" ]
  ] ;
  fhir:ExplanationOfBenefit.created [ fhir:value "2026-02-04"^^xsd:date] ;
  fhir:ExplanationOfBenefit.insurer [
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "urn:oid:2.16.840.1.113883.4.4" ] ;
       fhir:Identifier.value [ fhir:value "EXAMPLE-INSURER" ]
     ]
  ] ;
  fhir:ExplanationOfBenefit.provider [
     fhir:Reference.reference [ fhir:value "#ExampleClaimProviderOrganization" ]
  ] ;
  fhir:ExplanationOfBenefit.outcome [ fhir:value "complete"] ;
  fhir:ExplanationOfBenefit.insurance [
     fhir:index 0 ;
     fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ] ;
     fhir:ExplanationOfBenefit.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/haau3-coverage-two-payors> ;
       fhir:Reference.reference [ fhir:value "Coverage/haau3-coverage-two-payors" ]
     ]
  ] ;
  fhir:ExplanationOfBenefit.item [
     fhir:index 0 ;
     fhir:ExplanationOfBenefit.item.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ExplanationOfBenefit.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://bluebutton.cms.gov/resources/codesystem/hcpcs" ] ;
         fhir:Coding.code [ fhir:value "EXAMPLE01" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.item.servicedDate [ fhir:value "2026-02-01"^^xsd:date ]
  ] ;
  fhir:ExplanationOfBenefit.total [
     fhir:index 0 ;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.code [ fhir:value "submitted" ]
       ]
     ] ;
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "412.5"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "USD" ]
     ]
  ] .

<http://hl7.org/fhir/Patient/haau3-patient> a fhir:Patient .

<http://hl7.org/fhir/Coverage/haau3-coverage-two-payors> a fhir:Coverage .

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

<http://hl7.org/fhir/ExplanationOfBenefit/haau3-explanation-of-benefit-outpatient.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/ExplanationOfBenefit/haau3-explanation-of-benefit-outpatient.ttl> .