340B FHIR Exchange Implementation Guide
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: bundle-chargeback-adjudicated - 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:Bundle ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "bundle-chargeback-adjudicated"] ; # 
  fhir:type [ fhir:v "message"] ; # 
  fhir:timestamp [ fhir:v "2026-04-24T15:02:00Z"^^xsd:dateTime] ; # 
  fhir:entry ( [
fhir:fullUrl [
fhir:v "urn:uuid:77777777-7777-4777-8777-777777777777"^^xsd:anyURI ;
fhir:l <urn:uuid:77777777-7777-4777-8777-777777777777>     ] ;
    ( fhir:resource <urn:uuid:77777777-7777-4777-8777-777777777777> )
  ] [
fhir:fullUrl [
fhir:v "urn:uuid:88888888-8888-4888-8888-888888888888"^^xsd:anyURI ;
fhir:l <urn:uuid:88888888-8888-4888-8888-888888888888>     ] ;
    ( fhir:resource <urn:uuid:88888888-8888-4888-8888-888888888888> )
  ] [
fhir:fullUrl [
fhir:v "urn:uuid:33333333-3333-4333-8333-333333333333"^^xsd:anyURI ;
fhir:l <urn:uuid:33333333-3333-4333-8333-333333333333>     ] ;
    ( fhir:resource <urn:uuid:33333333-3333-4333-8333-333333333333> )
  ] [
fhir:fullUrl [
fhir:v "urn:uuid:55555555-5555-4555-8555-555555555555"^^xsd:anyURI ;
fhir:l <urn:uuid:55555555-5555-4555-8555-555555555555>     ] ;
    ( fhir:resource <urn:uuid:55555555-5555-4555-8555-555555555555> )
  ] ) . # 

<urn:uuid:77777777-7777-4777-8777-777777777777> a fhir:MessageHeader ;
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_null\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader </b></p><p><b>event</b>: events: 340b.chargeback.adjudicated (340b.chargeback.adjudicated)</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>urn:system:manufacturer-77</td></tr></table><p><b>focus</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-88888888-8888-4888-8888-888888888888\">ClaimResponse: extension = tx-1002,corr-9001; status = active; type = Pharmacy; use = claim; created = 2026-04-24; outcome = complete; disposition = Approved</a></p></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:event [
a fhir:Coding ;
fhir:system [
fhir:v "https://exchange.example.org/events"^^xsd:anyURI ;
fhir:l <https://exchange.example.org/events>     ] ;
fhir:code [ fhir:v "340b.chargeback.adjudicated" ]
  ] ; # 
  fhir:source [
fhir:endpoint [
fhir:v "urn:system:manufacturer-77"^^xsd:anyURI ;
fhir:l <urn:system:manufacturer-77>     ]
  ] ; # 
  fhir:focus ( [
fhir:l <urn:uuid:88888888-8888-4888-8888-888888888888> ;
fhir:reference [ fhir:v "urn:uuid:88888888-8888-4888-8888-888888888888" ]
  ] ) . # 

<urn:uuid:88888888-8888-4888-8888-888888888888> a fhir:ClaimResponse ;
  fhir:id [ fhir:v "cr-340b-1001"] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_cr-340b-1001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse cr-340b-1001</b></p><a name=\"cr-340b-1001\"> </a><a name=\"hccr-340b-1001\"> </a><p><b>340B Exchange Transaction ID Extension</b>: tx-1002</p><p><b>340B Correlation ID Extension</b>: corr-9001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}\">Pharmacy</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-33333333-3333-4333-8333-333333333333\">Pat Example  (no stated gender), DoB Unknown</a></p><p><b>created</b>: 2026-04-24</p><p><b>insurer</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-55555555-5555-4555-8555-555555555555\">Organization Example Manufacturer 77</a></p><p><b>request</b>: <a href=\"https://example.org/fhir/Claim/claim-340b-1001\">https://example.org/fhir/Claim/claim-340b-1001</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Approved</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:\">allowed</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>125.42</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:extension ( [
fhir:url [
fhir:v "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-exchange-transaction-id"^^xsd:anyURI ;
fhir:l <https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-exchange-transaction-id>     ] ;
fhir:value [
a fhir:String ;
fhir:v "tx-1002"     ]
  ] [
fhir:url [
fhir:v "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-correlation-id"^^xsd:anyURI ;
fhir:l <https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-correlation-id>     ] ;
fhir:value [
a fhir:String ;
fhir:v "corr-9001"     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>       ] ;
fhir:code [ fhir:v "pharmacy" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:patient [
fhir:l <urn:uuid:33333333-3333-4333-8333-333333333333> ;
fhir:reference [ fhir:v "urn:uuid:33333333-3333-4333-8333-333333333333" ]
  ] ; # 
  fhir:created [ fhir:v "2026-04-24"^^xsd:date] ; # 
  fhir:insurer [
fhir:l <urn:uuid:55555555-5555-4555-8555-555555555555> ;
fhir:reference [ fhir:v "urn:uuid:55555555-5555-4555-8555-555555555555" ]
  ] ; # 
  fhir:request [
fhir:l <https://example.org/fhir/Claim/claim-340b-1001> ;
fhir:reference [ fhir:v "https://example.org/fhir/Claim/claim-340b-1001" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:disposition [ fhir:v "Approved"] ; # 
  fhir:item ( [
fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    ( fhir:adjudication [
fhir:category [
fhir:text [ fhir:v "allowed" ]       ] ;
fhir:amount [
fhir:value [ fhir:v 125.42 ] ;
fhir:currency [ fhir:v "USD" ]       ]     ] )
  ] ) . # 

<urn:uuid:33333333-3333-4333-8333-333333333333> a fhir:Patient ;
  fhir:id [ fhir:v "p-001"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_p-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient p-001</b></p><a name=\"p-001\"> </a><a name=\"hcp-001\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Pat Example  (no stated gender), DoB Unknown</p><hr/></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:name ( [
fhir:family [ fhir:v "Example" ] ;
    ( fhir:given [ fhir:v "Pat" ] )
  ] ) . # 

<urn:uuid:55555555-5555-4555-8555-555555555555> a fhir:Organization ;
  fhir:id [ fhir:v "manufacturer-77"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_manufacturer-77\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization manufacturer-77</b></p><a name=\"manufacturer-77\"> </a><a name=\"hcmanufacturer-77\"> </a><p><b>name</b>: Example Manufacturer 77</p></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:name [ fhir:v "Example Manufacturer 77"] . #