Union of http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim and http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim

This is the set of resources that conform to either of the profiles RTPBC Request Using Claim (http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim) and RTPBC Request Using Claim (http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim). E.g. what you have to deal with if you get resources conforming to one of them

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..*Claim, Pre-determination or Pre-authorization
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.
... text 0..1NarrativeText summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S1..1IdentifierRTPBC request identifier
.... extension 0..*ExtensionAdditional content defined by implementations
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: ?? (required): Identifies the purpose for this identifier, if known .
.... type Σ0..1CodeableConceptDescription of identifier
Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
.... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ1..1stringUnique RTPBC request ID
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codeRequest status
Binding: ?? (required): A code specifying the state of the resource instance.
... type SΣ1..1CodeableConceptRequested Service Type
Binding: ?? (extensible): The type or discipline-style of the claim.
.... extension 0..*ExtensionAdditional content defined by implementations
.... coding SΣ1..1CodingCode defined by a terminology system
..... extension 0..*ExtensionAdditional content defined by implementations
..... system SΣ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code SΣ1..1codeSymbol in syntax defined by the system
..... display SΣ1..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
... use SΣ1..1codeProcessing Mode
Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ1..1Reference(RTPBC Patient | #sd-rtpbc-patient-rtpbc-patient)Request Patient Information
.... extension 0..*ExtensionAdditional content defined by implementations
.... reference SΣ1..1stringPatient Reference
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created SΣ1..1dateTimeCreated DateTime
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer Σ0..1Reference(Organization)Target
... provider SΣ1..1Reference(RTPBC Pharmacy Organization | #sd-rtpbc-pharmacy-organization-rtpbc-pharmacy-organization)Preferred Pharmacy
.... extension 0..*ExtensionAdditional content defined by implementations
.... reference SΣ1..1stringReference to Pharmacy Organization
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... priority SΣ1..1CodeableConceptProcessing priority
Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.
.... extension 0..*ExtensionAdditional content defined by implementations
.... coding SΣ1..1CodingCode defined by a terminology system
..... extension 0..*ExtensionAdditional content defined by implementations
..... system SΣ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code SΣ1..1codeSymbol in syntax defined by the system
..... display SΣ1..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... fundsReserve 0..1CodeableConceptFor whom to reserve funds
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..*BackboneElementPrior or corollary claims
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ?? (example): Relationship of this claim to a related Claim.
.... reference 0..1IdentifierFile or case reference
... prescription S1..1Reference(RTPBC Medication Request | #sd-rtpbc-medicationrequest-rtpbc-medicationrequest)Prescription Reference
.... extension 0..*ExtensionAdditional content defined by implementations
.... reference SΣ1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptCategory of recipient
Binding: ?? (example): A code for the party to be reimbursed.
.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Treatment referral
... facility 0..1Reference(Location)Servicing facility
... careTeam S1..1BackboneElementPrescriber
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence S1..1positiveIntOrder of care team
.... provider S1..1Reference(US Core Practitioner Profile | #sd-us-core-practitioner-us-core-practitioner)Prescriber
..... extension 0..*ExtensionAdditional content defined by implementations
..... reference SΣ1..1stringPrescriber Reference
..... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
..... display Σ0..1stringText alternative for the resource
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Binding: ?? (example): The role codes for the care team members.
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ?? (example): Provider professional qualifications.
... supportingInfo 0..*BackboneElementSupporting information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ?? (example): The valuset used for additional information category codes.
.... code 0..1CodeableConceptType of information
Binding: ?? (example): The valuset used for additional information codes.
.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason 0..1CodeableConceptExplanation for the information
Binding: ?? (example): Reason codes for the missing teeth.
... diagnosis 0..*BackboneElementPertinent diagnosis information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
Binding: ?? (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1CodeableConceptPresent on admission
Binding: ?? (example): Present on admission.
.... packageCode 0..1CodeableConceptPackage billing code
Binding: ?? (example): The DRG codes associated with the diagnosis.
... procedure 0..*BackboneElementClinical procedures performed
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntProcedure instance identifier
.... type 0..*CodeableConceptCategory of Procedure
Binding: ?? (example): Example procedure type codes.
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
Binding: ?? (example): Example ICD10 Procedure codes.
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Unique device identifier
... insurance SΣ1..1BackboneElementPharmacy Coverage
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence SΣ1..1positiveIntInsurance instance identifier
.... focal SΣ1..1booleanCoverage to be used for adjudication
.... identifier 0..1IdentifierPre-assigned Claim number
.... coverage SΣ1..1Reference(RTPBC Coverage | #sd-rtpbc-coverage-rtpbc-coverage)Pharmacy Coverage Reference
..... extension 0..*ExtensionAdditional content defined by implementations
..... reference SΣ0..1stringPharmacy Coverage Reference
..... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
..... display Σ0..1stringText alternative for the resource
.... businessArrangement 0..1stringAdditional provider contract number
.... preAuthRef 0..*stringPrior authorization reference number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... accident 0..1BackboneElementDetails of the event
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date 1..1dateWhen the incident occurred
.... type 0..1CodeableConceptThe nature of the accident
Binding: ?? (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item S1..1BackboneElementMax 1 item per request
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence S1..1positiveIntItem instance identifier
.... careTeamSequence S1..1positiveIntCare Team Sequence ID Reference
.... diagnosisSequence 0..*positiveIntApplicable diagnoses
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService S1..1CodeableConceptPrescribed Product
Binding: ?? (extensible): RTPBC prescribable product codes (NDC11 and RxNorm)
..... extension 0..*ExtensionAdditional content defined by implementations
..... coding SΣ1..*CodingCode defined by a terminology system
...... extension 0..*ExtensionAdditional content defined by implementations
...... system SΣ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeSymbol in syntax defined by the system
...... display SΣ1..1stringProduct Description
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
.... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity S1..1??Prescribed Quantity
..... extension 0..*ExtensionAdditional content defined by implementations
..... value SΣ1..1decimalQuantity in Billing Units
..... unit SΣ1..1stringBilling unit of measure
Binding: ?? (extensible): Billing quantity unit of measure
..... system Σ0..1uriSystem that defines coded unit form
..... code Σ0..1codeCoded form of the unit
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... udi 0..*Reference(Device)Unique device identifier
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.
.... encounter 0..*Reference(Encounter)Encounters related to this billed item
.... detail 0..*BackboneElementProduct or service provided
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntItem instance identifier
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
..... quantity 0..1??Count of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... udi 0..*Reference(Device)Unique device identifier
..... subDetail 0..*BackboneElementProduct or service provided
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence 1..1positiveIntItem instance identifier
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
...... quantity 0..1??Count of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... udi 0..*Reference(Device)Unique device identifier
... total 0..1MoneyTotal claim cost

doco Documentation for this format