2026 US Quality Core Implementation Guide
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2026 US Quality Core Implementation Guide - Local Development build (v0.5.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: ClaimResponse example - 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/ClaimResponse/example> a fhir:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "example"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-claimresponse" ;
       fhir:index 0 ;
       fhir:link <http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-claimresponse>
     ]
  ] ;
  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: ClaimResponse example</b></p><a name=\"example\"> </a><a name=\"hcexample\"> </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-us-quality-core-claimresponse.html\">US Quality Core ClaimResponse</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-example.html\">Jim Chalmers  Male, DoB: 1974-12-25 ( Social Security number (use: usual, period: 2001-05-06 --&gt; (ongoing)))</a></p><p><b>created</b>: 2018-02-24</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization Health Level Seven International</a></p><p><b>requestor</b>: <a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></p><p><b>request</b>: <a href=\"Claim-example.html\">Claim: identifier = http://example.org/claims#6612346; status = active; type = Professional; use = claim; created = 2014-08-16; priority = Normal</a></p><p><b>outcome</b>: Queued</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted 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>4000.00</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>detailSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted 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>4000.00</td><td>United States dollar</td></tr></table></blockquote></blockquote></blockquote></div>"
  ] ;
  fhir:ClaimResponse.status [ fhir:value "active"] ;
  fhir:ClaimResponse.type [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ] ;
       fhir:Coding.code [ fhir:value "professional" ] ;
       fhir:Coding.display [ fhir:value "Professional" ]
     ]
  ] ;
  fhir:ClaimResponse.use [ fhir:value "preauthorization"] ;
  fhir:ClaimResponse.patient [
     fhir:link <http://hl7.org/fhir/Patient/example> ;
     fhir:Reference.reference [ fhir:value "Patient/example" ]
  ] ;
  fhir:ClaimResponse.created [ fhir:value "2018-02-24"^^xsd:date] ;
  fhir:ClaimResponse.insurer [
     fhir:link <http://hl7.org/fhir/Organization/example> ;
     fhir:Reference.reference [ fhir:value "Organization/example" ]
  ] ;
  fhir:ClaimResponse.requestor [
     fhir:link <http://hl7.org/fhir/Practitioner/example> ;
     fhir:Reference.reference [ fhir:value "Practitioner/example" ]
  ] ;
  fhir:ClaimResponse.request [
     fhir:link <http://hl7.org/fhir/Claim/example> ;
     fhir:Reference.reference [ fhir:value "Claim/example" ]
  ] ;
  fhir:ClaimResponse.outcome [ fhir:value "queued"] ;
  fhir:ClaimResponse.item [
     fhir:index 0 ;
     fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ClaimResponse.item.adjudication [
       fhir:index 0 ;
       fhir:ClaimResponse.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:ClaimResponse.item.adjudication.amount [
         fhir:Money.value [ fhir:value "4000.00"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "USD" ]
       ]
     ] ;
     fhir:ClaimResponse.item.detail [
       fhir:index 0 ;
       fhir:ClaimResponse.item.detail.detailSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
       fhir:ClaimResponse.item.detail.adjudication [
         fhir:index 0 ;
         fhir:ClaimResponse.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:ClaimResponse.item.adjudication.amount [
           fhir:Money.value [ fhir:value "4000.00"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
       ]
     ]
  ] .

<http://hl7.org/fhir/Patient/example> a fhir:Patient .

<http://hl7.org/fhir/Organization/example> a fhir:Organization .

<http://hl7.org/fhir/Practitioner/example> a fhir:Practitioner .

<http://hl7.org/fhir/Claim/example> a fhir:Claim .

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

<http://hl7.org/fhir/ClaimResponse/example.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/ClaimResponse/example.ttl> .