Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions
Page standards status: Trial-use | Maturity Level: 2 |
Definitions for the davinci-pct-gfe-institutional resource profile.
Guidance on how to interpret the contents of this table can be found here
0. Claim | |
2. Claim.extension | |
Slicing | This element introduces a set of slices on Claim.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
4. Claim.extension:gfeServiceLinkingInfo | |
Slice Name | gfeServiceLinkingInfo |
Short | GFE Service Linking Information. |
Control | 0..1 |
Type | Extension(GFEServiceLinkingInfo) (Complex Extension) |
Must Support | true |
6. Claim.extension:providerEventMethodology | |
Slice Name | providerEventMethodology |
Definition | How the provider determined the number of claims and the number and type of billing providers to include in the GFE. Examples include provider episodes of care experience, PACES, order set based on clinical guidelines, payor suggested grouping, or some other method of determination. The extension definition contains additional detail. |
Short | Provider event collection methodology |
Control | 0..1 |
Type | Extension(ProviderEventMethodology) (Extension Type: string) |
Must Support | true |
8. Claim.extension:gfeDisclaimer | |
Slice Name | gfeDisclaimer |
Short | Disclaimers the patient should be made aware of regarding the providers estimate |
Control | 0..* |
Type | Extension(GFEDisclaimer) (Extension Type: string) |
Must Support | true |
10. Claim.identifier | |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 1..? |
Slicing | This element introduces a set of slices on Claim.identifier . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
12. Claim.identifier:PLAC | |
Slice Name | PLAC |
Short | Provider Assigned Identifier for GFE Claim |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 1..1 |
14. Claim.identifier:PLAC.type | |
Control | 1..? |
Pattern Value | { |
16. Claim.identifier:PLAC.system | |
Must Support | true |
18. Claim.identifier:PLAC.value | |
Control | 1..? |
20. Claim.identifier:INTER | |
Slice Name | INTER |
Short | Intermediary System Identifier |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..* |
22. Claim.identifier:INTER.type | |
Control | 1..? |
Pattern Value | { |
24. Claim.type | |
Pattern Value | { |
26. Claim.use | |
Pattern Value | predetermination |
28. Claim.patient | |
Type | Reference(HRex Patient Demographics) |
30. Claim.billablePeriod | |
Short | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims. |
Must Support | true |
32. Claim.insurer | |
Short | Required if insured estimate |
Type | Reference(PCT Organization) |
Must Support | true |
34. Claim.provider | |
Short | Billing provider - party responsible for the GFE |
Type | Reference(PCT Organization) |
36. Claim.provider.extension | |
Control | 1..? |
38. Claim.provider.extension:providerTaxonomy | |
Slice Name | providerTaxonomy |
Short | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers |
Control | 1..1 |
Type | Extension(ProviderTaxonomy) (Extension Type: CodeableConcept) |
40. Claim.provider.extension:consentForBalanceBilling | |
Slice Name | consentForBalanceBilling |
Control | 0..1 |
Type | Extension(GFEConsentForBalanceBilling) (Extension Type: boolean) |
Must Support | true |
42. Claim.priority | |
Binding | The codes SHALL be taken from ProcessPriorityCodes (required to http://hl7.org/fhir/ValueSet/process-priority ) |
44. Claim.payee | |
Must Support | true |
46. Claim.payee.party | |
Type | Reference(PCT Practitioner, PCT Organization) |
48. Claim.referral | |
50. Claim.referral.extension | |
Control | 1..? |
52. Claim.referral.extension:referralNumber | |
Slice Name | referralNumber |
Short | Referral Number |
Control | 1..1 |
Type | Extension(ReferralNumber) (Extension Type: string) |
54. Claim.careTeam | |
Must Support | true |
Slicing | This element introduces a set of slices on Claim.careTeam . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
56. Claim.careTeam.provider | |
Type | Reference(PCT Practitioner, PCT Organization) |
58. Claim.careTeam.role | |
Control | 1..? |
Binding | The codes SHALL be taken from PCT Care Team Role Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS ) |
60. Claim.careTeam.qualification | |
Binding | The codes SHALL be taken from US Core Provider Role (NUCC) (required to http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role ) |
62. Claim.careTeam:attending | |
Slice Name | attending |
Control | 0..1 |
Must Support | true |
64. Claim.careTeam:attending.provider | |
Type | Reference(PCT Practitioner) |
66. Claim.careTeam:attending.role | |
Pattern Value | { |
68. Claim.careTeam:attending.qualification | |
Control | 1..? |
70. Claim.careTeam:operating | |
Slice Name | operating |
Control | 0..2 |
Must Support | true |
72. Claim.careTeam:operating.provider | |
Type | Reference(PCT Practitioner) |
74. Claim.careTeam:operating.role | |
Pattern Value | { |
76. Claim.careTeam:rendering | |
Slice Name | rendering |
Control | 0..1 |
Must Support | true |
78. Claim.careTeam:rendering.provider | |
Type | Reference(PCT Practitioner) |
80. Claim.careTeam:rendering.role | |
Pattern Value | { |
82. Claim.careTeam:referring | |
Slice Name | referring |
Control | 0..1 |
Must Support | true |
84. Claim.careTeam:referring.role | |
Pattern Value | { |
86. Claim.supportingInfo | |
Control | 1..? |
Must Support | true |
Slicing | This element introduces a set of slices on Claim.supportingInfo . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
88. Claim.supportingInfo.category | |
Binding | Unless not suitable, these codes SHALL be taken from PCT Supporting Info Type Value Set (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS ) |
90. Claim.supportingInfo:typeOfBill | |
Slice Name | typeOfBill |
Control | 1..1 |
92. Claim.supportingInfo:typeOfBill.category | |
Pattern Value | { |
94. Claim.supportingInfo:typeOfBill.code | |
Control | 1..? |
Binding | The codes SHALL be taken from PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFETypeOfBillVS ) |
96. Claim.supportingInfo:serviceFacility | |
Slice Name | serviceFacility |
Short | Service Facility |
Comments | Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider. |
Control | 0..1 |
Must Support | true |
98. Claim.supportingInfo:serviceFacility.category | |
Pattern Value | { |
100. Claim.supportingInfo:serviceFacility.value[x] | |
Control | 1..? |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Slicing | This element introduces a set of slices on Claim.supportingInfo.value[x] . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
102. Claim.supportingInfo:serviceFacility.value[x]:valueReference | |
Slice Name | valueReference |
Control | 1..1 |
Type | Reference(PCT Organization) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
104. Claim.supportingInfo:drg | |
Slice Name | drg |
Control | 0..1 |
106. Claim.supportingInfo:drg.category | |
Pattern Value | { |
108. Claim.supportingInfo:drg.code | |
Binding | The codes SHALL be taken from US Claim DRG Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimDRGCodes ) |
110. Claim.supportingInfo:pointoforigin | |
Slice Name | pointoforigin |
Control | 0..1 |
112. Claim.supportingInfo:pointoforigin.category | |
Pattern Value | { |
114. Claim.supportingInfo:pointoforigin.code | |
Binding | The codes SHALL be taken from NUBC Point Of Origin (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPointOfOriginVS ) |
116. Claim.supportingInfo:admtype | |
Slice Name | admtype |
Control | 0..1 |
118. Claim.supportingInfo:admtype.category | |
Pattern Value | { |
120. Claim.supportingInfo:admtype.code | |
Binding | The codes SHALL be taken from NUBC Priority (Type) of Admission or Visit (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisitVS ) |
122. Claim.diagnosis | |
Control | 1..? |
Must Support | true |
Slicing | This element introduces a set of slices on Claim.diagnosis . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
124. Claim.diagnosis.type | |
Binding | The codes SHALL be taken from PCT Diagnosis Type Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS ) |
Must Support | true |
126. Claim.diagnosis:principal | |
Slice Name | principal |
Control | 1..1 |
128. Claim.diagnosis:principal.sequence | |
Pattern Value | 1 |
130. Claim.diagnosis:principal.diagnosis[x] | |
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
132. Claim.diagnosis:principal.type | |
Control | 1..1 |
Pattern Value | { |
134. Claim.diagnosis:admitting | |
Slice Name | admitting |
Control | 0..1 |
Must Support | true |
136. Claim.diagnosis:admitting.diagnosis[x] | |
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
138. Claim.diagnosis:admitting.type | |
Control | 1..1 |
Pattern Value | { |
140. Claim.diagnosis:patientReasonForVisit | |
Slice Name | patientReasonForVisit |
Control | 0..3 |
Must Support | true |
142. Claim.diagnosis:patientReasonForVisit.diagnosis[x] | |
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
144. Claim.diagnosis:patientReasonForVisit.type | |
Control | 1..1 |
Pattern Value | { |
146. Claim.diagnosis:externalcauseofinjury | |
Slice Name | externalcauseofinjury |
Control | 0..12 |
Must Support | true |
148. Claim.diagnosis:externalcauseofinjury.diagnosis[x] | |
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
150. Claim.diagnosis:externalcauseofinjury.type | |
Control | 1..1 |
Pattern Value | { |
152. Claim.diagnosis:other | |
Slice Name | other |
Control | 0..24 |
Must Support | true |
154. Claim.diagnosis:other.diagnosis[x] | |
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Must Support | true |
156. Claim.diagnosis:other.type | |
Control | 1..1 |
Pattern Value | { |
158. Claim.procedure | |
Must Support | true |
Slicing | This element introduces a set of slices on Claim.procedure . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
160. Claim.procedure.extension | |
Control | 1..? |
Slicing | This element introduces a set of slices on Claim.procedure.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
162. Claim.procedure.extension:serviceDescription | |
Slice Name | serviceDescription |
Control | 1..1 |
Type | Extension(Service Description) (Extension Type: string) |
164. Claim.procedure.type | |
Binding | The codes SHALL be taken from PCT Procedure Type Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS ) |
Must Support | true |
166. Claim.procedure:principal | |
Slice Name | principal |
Short | Principal clinical procedure performed |
Control | 0..1 |
Must Support | true |
168. Claim.procedure:principal.extension:serviceDescription | |
Slice Name | serviceDescription |
Control | 1..1 |
Type | Extension(Service Description) (Extension Type: string) |
170. Claim.procedure:principal.sequence | |
Pattern Value | 1 |
172. Claim.procedure:principal.type | |
Control | 1..1 |
Pattern Value | { |
174. Claim.procedure:principal.procedure[x] | |
Binding | The codes SHALL be taken from ICD-10 Procedure Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes ) |
Type | CodeableConcept |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
176. Claim.procedure:other | |
Slice Name | other |
Control | 0..24 |
Must Support | true |
178. Claim.procedure:other.extension:serviceDescription | |
Slice Name | serviceDescription |
Control | 1..1 |
Type | Extension(Service Description) (Extension Type: string) |
180. Claim.procedure:other.type | |
Control | 1..1 |
Pattern Value | { |
182. Claim.procedure:other.procedure[x] | |
Binding | The codes SHALL be taken from PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes ) |
Type | CodeableConcept |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
184. Claim.insurance | |
186. Claim.insurance.coverage | |
Type | Reference(PCT Coverage) |
188. Claim.insurance.coverage.extension:dataAbsentReason | |
Slice Name | dataAbsentReason |
Short | Coverage may be not applicable if estimate is for self-pay or uninsured |
Control | 0..1 |
Type | Extension(Data Absent Reason) (Extension Type: code) |
Must Support | true |
190. Claim.insurance.preAuthRef | |
Control | 0..1 |
192. Claim.accident | |
194. Claim.accident.location[x] | |
Type | Address, Reference(Location) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
196. Claim.accident.location[x].country | |
Binding | The codes SHALL be taken from Iso3166-1-2 (required to http://hl7.org/fhir/ValueSet/iso3166-1-2 ) |
198. Claim.item | |
Control | 1..999 |
200. Claim.item.extension | |
Control | 1..? |
Slicing | This element introduces a set of slices on Claim.item.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
202. Claim.item.extension:gfeBillingProviderLineItemCtrlNum | |
Slice Name | gfeBillingProviderLineItemCtrlNum |
Control | 0..1 |
Type | Extension(GFEBillingProviderLineItemCtrlNum) (Extension Type: Identifier) |
Must Support | true |
204. Claim.item.extension:serviceDescription | |
Slice Name | serviceDescription |
Control | 1..1 |
Type | Extension(Service Description) (Extension Type: string) |
206. Claim.item.extension:ProviderEventMethodology | |
Slice Name | ProviderEventMethodology |
Short | Provider Event Methodology |
Comments | The method a provider used to group services. The extension definition contains additional detail |
Control | 0..1 |
Type | Extension(ProviderEventMethodology) (Extension Type: string) |
Must Support | true |
208. Claim.item.revenue | |
Short | Revenue or cost center code - must provide a value for the Institutional case |
Control | 1..? |
Binding | The codes SHALL be taken from PCT GFE NUBC Revenue Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemRevenueVS ) |
210. Claim.item.productOrService | |
Comments | Can include null or N/A or data absent reason for the In-Patient Institutional case. |
Binding | The codes SHALL be taken from Claim Medical Product or Service Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes ) |
212. Claim.item.modifier | |
Control | 0..4 |
Binding | The codes SHALL be taken from PCT GFE Item CPT - HCPCS Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS ) |
Must Support | true |
214. Claim.item.serviced[x] | |
Definition | This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication |
Short | This is the planned or estimated date(s)s of service |
Control | 1..? |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Must Support | true |
216. Claim.item.location[x] | |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Slicing | This element introduces a set of slices on Claim.item.location[x] . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
218. Claim.item.location[x]:locationCodeableConcept | |
Slice Name | locationCodeableConcept |
Control | 0..1 |
Binding | The codes SHALL be taken from PCT GFE CMS Place of Service Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOS ) |
Type | CodeableConcept |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Must Support | true |
220. Claim.item.quantity | |
Control | 1..? |
222. Claim.item.net | |
Short | Total charge amount for the service line |
Control | 1..? |
224. Claim.item.detail | |
Short | Drug Identification Information |
Must Support | true |
226. Claim.item.detail.productOrService | |
Binding | The codes SHALL be taken from PCT GFE Item NDC Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemNDCVS ) |
228. Claim.item.detail.quantity | |
Must Support | true |
230. Claim.total | |
Short | Total GFE Charges Submitted |
Control | 1..? |
Guidance on how to interpret the contents of this table can be found here
0. Claim | |
Definition | A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement. |
Short | Claim, Pre-determination or Pre-authorization |
Comments | The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services. |
Control | 0..* |
Is Modifier | false |
Summary | false |
Alternate Names | Adjudication Request, Preauthorization Request, Predetermination Request |
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) |
2. Claim.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Short | A set of rules under which this content was created |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
4. Claim.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on Claim.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
6. Claim.extension:gfeServiceLinkingInfo | |
Slice Name | gfeServiceLinkingInfo |
Definition | This extension is used to provide the GFE Service Linking Information. This allows implementers to have the same identifier on multiple GFEs that are part of one period of care's services. This would be needed for some of the workflow options that businesses may decide to use. |
Short | GFE Service Linking Information. |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | Extension(GFEServiceLinkingInfo) (Complex Extension) |
Is Modifier | false |
Must Support | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
8. Claim.extension:providerEventMethodology | |
Slice Name | providerEventMethodology |
Definition | How the provider determined the number of claims and the number and type of billing providers to include in the GFE. Examples include provider episodes of care experience, PACES, order set based on clinical guidelines, payor suggested grouping, or some other method of determination. The extension definition contains additional detail. |
Short | Provider event collection methodology |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | Extension(ProviderEventMethodology) (Extension Type: string) |
Is Modifier | false |
Must Support | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
10. Claim.extension:gfeDisclaimer | |
Slice Name | gfeDisclaimer |
Definition | Disclaimers the patient should be made aware of regarding the providers estimate |
Short | Disclaimers the patient should be made aware of regarding the providers estimate |
Control | 0..* This element is affected by the following invariants: ele-1 |
Type | Extension(GFEDisclaimer) (Extension Type: string) |
Is Modifier | false |
Must Support | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
12. Claim.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
Summary | false |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
14. Claim.identifier | |
Definition | A unique identifier assigned to this claim. |
Short | Business Identifier for claim |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 10..* |
Type | Identifier |
Is Modifier | false |
Summary | false |
Requirements | Allows claims to be distinguished and referenced. |
Alternate Names | Claim Number |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on Claim.identifier . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
16. Claim.identifier:PLAC | |
Slice Name | PLAC |
Definition | A unique identifier assigned to this claim. |
Short | Provider Assigned Identifier for GFE ClaimBusiness Identifier for claim |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 10..1* |
Type | Identifier |
Is Modifier | false |
Summary | false |
Requirements | Allows claims to be distinguished and referenced. |
Alternate Names | Claim Number |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
18. Claim.identifier:PLAC.use | |
Definition | The purpose of this identifier. |
Short | usual | official | temp | secondary | old (If known) |
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
Control | 0..1 |
Binding | The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 )Identifies the purpose for this identifier, if known . |
Type | code |
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
20. Claim.identifier:PLAC.type | |
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. |
Short | Description of identifier |
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. |
Control | 10..1 |
Binding | Unless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type (extensible to http://hl7.org/fhir/ValueSet/identifier-type )A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
Type | CodeableConcept |
Is Modifier | false |
Summary | true |
Requirements | Allows users to make use of identifiers when the identifier system is not known. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
22. Claim.identifier:PLAC.system | |
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. |
Short | The namespace for the identifier value |
Comments | Identifier.system is always case sensitive. |
Control | 0..1 |
Type | uri |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Summary | true |
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. |
Example | <br/><b>General</b>:http://www.acme.com/identifiers/patient |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
24. Claim.identifier:PLAC.value | |
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. |
Short | The value that is unique |
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. |
Control | 10..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Example | <br/><b>General</b>:123456 |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
26. Claim.identifier:INTER | |
Slice Name | INTER |
Definition | A unique identifier assigned to this claim. |
Short | Intermediary System IdentifierBusiness Identifier for claim |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Summary | false |
Requirements | Allows claims to be distinguished and referenced. |
Alternate Names | Claim Number |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
28. Claim.identifier:INTER.use | |
Definition | The purpose of this identifier. |
Short | usual | official | temp | secondary | old (If known) |
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
Control | 0..1 |
Binding | The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 )Identifies the purpose for this identifier, if known . |
Type | code |
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
30. Claim.identifier:INTER.type | |
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. |
Short | Description of identifier |
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. |
Control | 10..1 |
Binding | Unless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type (extensible to http://hl7.org/fhir/ValueSet/identifier-type )A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
Type | CodeableConcept |
Is Modifier | false |
Summary | true |
Requirements | Allows users to make use of identifiers when the identifier system is not known. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
32. Claim.status | |
Definition | The status of the resource instance. |
Short | active | cancelled | draft | entered-in-error |
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
Control | 1..1 |
Binding | The codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1 )A code specifying the state of the resource instance. |
Type | code |
Is Modifier | true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
34. Claim.type | |
Definition | The category of claim, e.g. oral, pharmacy, vision, institutional, professional. |
Short | Category or discipline |
Comments | The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements. |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type (extensible to http://hl7.org/fhir/ValueSet/claim-type )The type or discipline-style of the claim. |
Type | CodeableConcept |
Is Modifier | false |
Summary | true |
Requirements | Claim type determine the general sets of business rules applied for information requirements and adjudication. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
36. Claim.use | |
Definition | A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future. |
Short | claim | preauthorization | predetermination |
Control | 1..1 |
Binding | The codes SHALL be taken from Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1 )The purpose of the Claim: predetermination, preauthorization, claim. |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | This element is required to understand the nature of the request for adjudication. |
Pattern Value | predetermination |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
38. Claim.patient | |
Definition | The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought. |
Short | The recipient of the products and services |
Control | 1..1 |
Type | Reference(HRex Patient Demographics, Patient) |
Is Modifier | false |
Summary | true |
Requirements | The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
40. Claim.billablePeriod | |
Definition | The period for which charges are being submitted. |
Short | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims. |
Comments | Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified. |
Control | 0..1 |
Type | Period |
Is Modifier | false |
Must Support | true |
Summary | true |
Requirements | A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
42. Claim.created | |
Definition | The date this resource was created. |
Short | Resource creation date |
Comments | This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. |
Control | 1..1 |
Type | dateTime |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to record a timestamp for use by both the recipient and the issuer. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
44. Claim.insurer | |
Definition | The Insurer who is target of the request. |
Short | Required if insured estimateTarget |
Control | 0..1 |
Type | Reference(PCT Organization, Organization) |
Is Modifier | false |
Must Support | true |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
46. Claim.provider | |
Definition | The provider which is responsible for the claim, predetermination or preauthorization. |
Short | Billing provider - party responsible for the GFEParty responsible for the claim |
Comments | Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. |
Control | 1..1 |
Type | Reference(PCT Organization, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
48. Claim.provider.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 10..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on Claim.provider.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
50. Claim.provider.extension:providerTaxonomy | |
Slice Name | providerTaxonomy |
Definition | This extension is used to indicate the taxonomy code of the provider. |
Short | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers |
Control | 1..1 |
Type | Extension(ProviderTaxonomy) (Extension Type: CodeableConcept) |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
52. Claim.provider.extension:consentForBalanceBilling | |
Slice Name | consentForBalanceBilling |
Definition | If the provider has received a written consent form indicating a patient has agreed to waive their protections and pay up to the full cost for the out-of-network item or service, this will be “true”. If the provider has not received written consent, this will be “false”. This is an attestation only. The billing provider is legally required to maintain the written notice and consent form. |
Short | Extension |
Control | 0..1 |
Type | Extension(GFEConsentForBalanceBilling) (Extension Type: boolean) |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
54. Claim.priority | |
Definition | The provider-required urgency of processing the request. Typical values include: stat, routine deferred. |
Short | Desired processing ugency |
Comments | If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request. |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority (required to http://hl7.org/fhir/ValueSet/process-priority ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | true |
Requirements | The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
56. Claim.payee | |
Definition | The party to be reimbursed for cost of the products and services according to the terms of the policy. |
Short | Recipient of benefits payable |
Comments | Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead. |
Control | 0..1 |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
58. Claim.payee.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
60. Claim.payee.type | |
Definition | Type of Party to be reimbursed: subscriber, provider, other. |
Short | Category of recipient |
Control | 1..1 |
Binding | For example codes, see Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype (example to http://hl7.org/fhir/ValueSet/payeetype )A code for the party to be reimbursed. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
62. Claim.payee.party | |
Definition | Reference to the individual or organization to whom any payment will be made. |
Short | Recipient reference |
Comments | Not required if the payee is 'subscriber' or 'provider'. |
Control | 0..1 |
Type | Reference(PCT Practitioner, PCT Organization, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson) |
Is Modifier | false |
Summary | false |
Requirements | Need to provide demographics if the payee is not 'subscriber' nor 'provider'. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
64. Claim.careTeam | |
Definition | The members of the team who provided the products and services. |
Short | Members of the care team |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Common to identify the responsible and supporting practitioners. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on Claim.careTeam . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
66. Claim.careTeam.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
68. Claim.careTeam.sequence | |
Definition | A number to uniquely identify care team entries. |
Short | Order of care team |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
70. Claim.careTeam.provider | |
Definition | Member of the team who provided the product or service. |
Short | Practitioner or organization |
Control | 1..1 |
Type | Reference(PCT Practitioner, PCT Organization, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Summary | false |
Requirements | Often a regulatory requirement to specify the responsible provider. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
72. Claim.careTeam.role | |
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. |
Short | Function within the team |
Comments | Role might not be required when there is only a single provider listed. |
Control | 10..1 |
Binding | The codes SHALL be taken from For example codes, see PCT Care Team Role Value Sethttp://hl7.org/fhir/ValueSet/claim-careteamrole (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
74. Claim.careTeam.qualification | |
Definition | The qualification of the practitioner which is applicable for this service. |
Short | Practitioner credential or specialization |
Control | 0..1 |
Binding | The codes SHALL be taken from For example codes, see US Core Provider Role (NUCC)http://hl7.org/fhir/ValueSet/provider-qualification (required to http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Need to specify which qualification a provider is delivering the product or service under. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
76. Claim.careTeam:attending | |
Slice Name | attending |
Definition | The members of the team who provided the products and services. |
Short | Members of the care team |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Common to identify the responsible and supporting practitioners. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
78. Claim.careTeam:attending.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
80. Claim.careTeam:attending.sequence | |
Definition | A number to uniquely identify care team entries. |
Short | Order of care team |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
82. Claim.careTeam:attending.provider | |
Definition | Member of the team who provided the product or service. |
Short | Practitioner or organization |
Control | 1..1 |
Type | Reference(PCT Practitioner, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Summary | false |
Requirements | Often a regulatory requirement to specify the responsible provider. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
84. Claim.careTeam:attending.role | |
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. |
Short | Function within the team |
Comments | Role might not be required when there is only a single provider listed. |
Control | 0..1 |
Binding | For example codes, see ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole (example to http://hl7.org/fhir/ValueSet/claim-careteamrole )The role codes for the care team members. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
86. Claim.careTeam:attending.qualification | |
Definition | The qualification of the practitioner which is applicable for this service. |
Short | Practitioner credential or specialization |
Control | 10..1 |
Binding | For example codes, see ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualification (example to http://hl7.org/fhir/ValueSet/provider-qualification )Provider professional qualifications. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Need to specify which qualification a provider is delivering the product or service under. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
88. Claim.careTeam:operating | |
Slice Name | operating |
Definition | The members of the team who provided the products and services. |
Short | Members of the care team |
Control | 0..2* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Common to identify the responsible and supporting practitioners. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
90. Claim.careTeam:operating.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
92. Claim.careTeam:operating.sequence | |
Definition | A number to uniquely identify care team entries. |
Short | Order of care team |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
94. Claim.careTeam:operating.provider | |
Definition | Member of the team who provided the product or service. |
Short | Practitioner or organization |
Control | 1..1 |
Type | Reference(PCT Practitioner, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Summary | false |
Requirements | Often a regulatory requirement to specify the responsible provider. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
96. Claim.careTeam:operating.role | |
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. |
Short | Function within the team |
Comments | Role might not be required when there is only a single provider listed. |
Control | 0..1 |
Binding | For example codes, see ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole (example to http://hl7.org/fhir/ValueSet/claim-careteamrole )The role codes for the care team members. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
98. Claim.careTeam:rendering | |
Slice Name | rendering |
Definition | The members of the team who provided the products and services. |
Short | Members of the care team |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Common to identify the responsible and supporting practitioners. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
100. Claim.careTeam:rendering.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
102. Claim.careTeam:rendering.sequence | |
Definition | A number to uniquely identify care team entries. |
Short | Order of care team |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
104. Claim.careTeam:rendering.provider | |
Definition | Member of the team who provided the product or service. |
Short | Practitioner or organization |
Control | 1..1 |
Type | Reference(PCT Practitioner, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Summary | false |
Requirements | Often a regulatory requirement to specify the responsible provider. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
106. Claim.careTeam:rendering.role | |
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. |
Short | Function within the team |
Comments | Role might not be required when there is only a single provider listed. |
Control | 0..1 |
Binding | For example codes, see ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole (example to http://hl7.org/fhir/ValueSet/claim-careteamrole )The role codes for the care team members. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
108. Claim.careTeam:referring | |
Slice Name | referring |
Definition | The members of the team who provided the products and services. |
Short | Members of the care team |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Common to identify the responsible and supporting practitioners. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
110. Claim.careTeam:referring.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
112. Claim.careTeam:referring.sequence | |
Definition | A number to uniquely identify care team entries. |
Short | Order of care team |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
114. Claim.careTeam:referring.provider | |
Definition | Member of the team who provided the product or service. |
Short | Practitioner or organization |
Control | 1..1 |
Type | Reference(Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Summary | false |
Requirements | Often a regulatory requirement to specify the responsible provider. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
116. Claim.careTeam:referring.role | |
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. |
Short | Function within the team |
Comments | Role might not be required when there is only a single provider listed. |
Control | 0..1 |
Binding | For example codes, see ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole (example to http://hl7.org/fhir/ValueSet/claim-careteamrole )The role codes for the care team members. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
118. Claim.supportingInfo | |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Short | Supporting information |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on Claim.supportingInfo . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
120. Claim.supportingInfo.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
122. Claim.supportingInfo.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Short | Information instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
124. Claim.supportingInfo.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Short | Classification of the supplied information |
Comments | This may contain a category for the local bill type codes. |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from For example codes, see PCT Supporting Info Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
126. Claim.supportingInfo:typeOfBill | |
Slice Name | typeOfBill |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Short | Supporting information |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Control | 10..1* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
128. Claim.supportingInfo:typeOfBill.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
130. Claim.supportingInfo:typeOfBill.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Short | Information instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
132. Claim.supportingInfo:typeOfBill.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Short | Classification of the supplied information |
Comments | This may contain a category for the local bill type codes. |
Control | 1..1 |
Binding | For example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
134. Claim.supportingInfo:typeOfBill.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Short | Type of information |
Control | 10..1 |
Binding | The codes SHALL be taken from For example codes, see PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Sethttp://hl7.org/fhir/ValueSet/claim-exception (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFETypeOfBillVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to identify the kind of additional information. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
136. Claim.supportingInfo:serviceFacility | |
Slice Name | serviceFacility |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Short | Service FacilitySupporting information |
Comments | Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider. Often there are multiple jurisdiction specific valuesets which are required. |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
138. Claim.supportingInfo:serviceFacility.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
140. Claim.supportingInfo:serviceFacility.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Short | Information instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
142. Claim.supportingInfo:serviceFacility.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Short | Classification of the supplied information |
Comments | This may contain a category for the local bill type codes. |
Control | 1..1 |
Binding | For example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
144. Claim.supportingInfo:serviceFacility.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Short | Data to be provided |
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. |
Control | 10..1 |
Type | Reference(Resource), boolean, string, Quantity, Attachment |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on Claim.supportingInfo.value[x] . The slices areUnordered and Closed, and can be differentiated using the following discriminators: |
146. Claim.supportingInfo:serviceFacility.value[x]:valueReference | |
Slice Name | valueReference |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Short | Data to be provided |
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. |
Control | 10..1 |
Type | Reference(PCT Organization, Resource), boolean, string, Quantity, Attachment |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
148. Claim.supportingInfo:drg | |
Slice Name | drg |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Short | Supporting information |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
150. Claim.supportingInfo:drg.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
152. Claim.supportingInfo:drg.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Short | Information instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
154. Claim.supportingInfo:drg.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Short | Classification of the supplied information |
Comments | This may contain a category for the local bill type codes. |
Control | 1..1 |
Binding | For example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
156. Claim.supportingInfo:drg.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Short | Type of information |
Control | 0..1 |
Binding | The codes SHALL be taken from For example codes, see US Claim DRG Codeshttp://hl7.org/fhir/ValueSet/claim-exception (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimDRGCodes ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to identify the kind of additional information. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
158. Claim.supportingInfo:pointoforigin | |
Slice Name | pointoforigin |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Short | Supporting information |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
160. Claim.supportingInfo:pointoforigin.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
162. Claim.supportingInfo:pointoforigin.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Short | Information instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
164. Claim.supportingInfo:pointoforigin.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Short | Classification of the supplied information |
Comments | This may contain a category for the local bill type codes. |
Control | 1..1 |
Binding | For example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
166. Claim.supportingInfo:pointoforigin.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Short | Type of information |
Control | 0..1 |
Binding | The codes SHALL be taken from For example codes, see NUBC Point Of Originhttp://hl7.org/fhir/ValueSet/claim-exception (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPointOfOriginVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to identify the kind of additional information. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
168. Claim.supportingInfo:admtype | |
Slice Name | admtype |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Short | Supporting information |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
170. Claim.supportingInfo:admtype.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
172. Claim.supportingInfo:admtype.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Short | Information instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
174. Claim.supportingInfo:admtype.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Short | Classification of the supplied information |
Comments | This may contain a category for the local bill type codes. |
Control | 1..1 |
Binding | For example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
176. Claim.supportingInfo:admtype.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Short | Type of information |
Control | 0..1 |
Binding | The codes SHALL be taken from For example codes, see NUBC Priority (Type) of Admission or Visithttp://hl7.org/fhir/ValueSet/claim-exception (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisitVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Required to identify the kind of additional information. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
178. Claim.diagnosis | |
Definition | Information about diagnoses relevant to the claim items. |
Short | Pertinent diagnosis information |
Control | 10..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Required for the adjudication by provided context for the services and product listed. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on Claim.diagnosis . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
180. Claim.diagnosis.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
182. Claim.diagnosis.sequence | |
Definition | A number to uniquely identify diagnosis entries. |
Short | Diagnosis instance identifier |
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
184. Claim.diagnosis.diagnosis[x] | |
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. |
Short | Nature of illness or problem |
Control | 1..1 |
Binding | For example codes, see ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 (example to http://hl7.org/fhir/ValueSet/icd-10 )Example ICD10 Diagnostic codes. |
Type | Choice of: CodeableConcept, Reference(Condition) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | Provides health context for the evaluation of the products and/or services. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
186. Claim.diagnosis.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Timing or nature of the diagnosis |
Comments | For example: admitting, primary, secondary, discharge. |
Control | 0..* |
Binding | The codes SHALL be taken from For example codes, see PCT Diagnosis Type Value Sethttp://hl7.org/fhir/ValueSet/ex-diagnosistype (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
188. Claim.diagnosis:principal | |
Slice Name | principal |
Definition | Information about diagnoses relevant to the claim items. |
Short | Pertinent diagnosis information |
Control | 10..1* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Requirements | Required for the adjudication by provided context for the services and product listed. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
190. Claim.diagnosis:principal.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
192. Claim.diagnosis:principal.sequence | |
Definition | A number to uniquely identify diagnosis entries. |
Short | Diagnosis instance identifier |
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. |
Pattern Value | 1 |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
194. Claim.diagnosis:principal.diagnosis[x] | |
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. |
Short | Nature of illness or problem |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10 (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept, Reference(Condition) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | Provides health context for the evaluation of the products and/or services. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
196. Claim.diagnosis:principal.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Timing or nature of the diagnosis |
Comments | For example: admitting, primary, secondary, discharge. |
Control | 10..1* |
Binding | For example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
198. Claim.diagnosis:admitting | |
Slice Name | admitting |
Definition | Information about diagnoses relevant to the claim items. |
Short | Pertinent diagnosis information |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Required for the adjudication by provided context for the services and product listed. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
200. Claim.diagnosis:admitting.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
202. Claim.diagnosis:admitting.sequence | |
Definition | A number to uniquely identify diagnosis entries. |
Short | Diagnosis instance identifier |
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
204. Claim.diagnosis:admitting.diagnosis[x] | |
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. |
Short | Nature of illness or problem |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10 (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept, Reference(Condition) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | Provides health context for the evaluation of the products and/or services. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
206. Claim.diagnosis:admitting.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Timing or nature of the diagnosis |
Comments | For example: admitting, primary, secondary, discharge. |
Control | 10..1* |
Binding | For example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
208. Claim.diagnosis:patientReasonForVisit | |
Slice Name | patientReasonForVisit |
Definition | Information about diagnoses relevant to the claim items. |
Short | Pertinent diagnosis information |
Control | 0..3* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Required for the adjudication by provided context for the services and product listed. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
210. Claim.diagnosis:patientReasonForVisit.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
212. Claim.diagnosis:patientReasonForVisit.sequence | |
Definition | A number to uniquely identify diagnosis entries. |
Short | Diagnosis instance identifier |
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
214. Claim.diagnosis:patientReasonForVisit.diagnosis[x] | |
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. |
Short | Nature of illness or problem |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10 (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept, Reference(Condition) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | Provides health context for the evaluation of the products and/or services. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
216. Claim.diagnosis:patientReasonForVisit.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Timing or nature of the diagnosis |
Comments | For example: admitting, primary, secondary, discharge. |
Control | 10..1* |
Binding | For example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
218. Claim.diagnosis:externalcauseofinjury | |
Slice Name | externalcauseofinjury |
Definition | Information about diagnoses relevant to the claim items. |
Short | Pertinent diagnosis information |
Control | 0..12* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Required for the adjudication by provided context for the services and product listed. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
220. Claim.diagnosis:externalcauseofinjury.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
222. Claim.diagnosis:externalcauseofinjury.sequence | |
Definition | A number to uniquely identify diagnosis entries. |
Short | Diagnosis instance identifier |
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
224. Claim.diagnosis:externalcauseofinjury.diagnosis[x] | |
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. |
Short | Nature of illness or problem |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10 (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept, Reference(Condition) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | Provides health context for the evaluation of the products and/or services. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
226. Claim.diagnosis:externalcauseofinjury.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Timing or nature of the diagnosis |
Comments | For example: admitting, primary, secondary, discharge. |
Control | 10..1* |
Binding | For example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
228. Claim.diagnosis:other | |
Slice Name | other |
Definition | Information about diagnoses relevant to the claim items. |
Short | Pertinent diagnosis information |
Control | 0..24* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Required for the adjudication by provided context for the services and product listed. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
230. Claim.diagnosis:other.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
232. Claim.diagnosis:other.sequence | |
Definition | A number to uniquely identify diagnosis entries. |
Short | Diagnosis instance identifier |
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
234. Claim.diagnosis:other.diagnosis[x] | |
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. |
Short | Nature of illness or problem |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10 (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) |
Type | CodeableConcept, Reference(Condition) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Provides health context for the evaluation of the products and/or services. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
236. Claim.diagnosis:other.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Timing or nature of the diagnosis |
Comments | For example: admitting, primary, secondary, discharge. |
Control | 10..1* |
Binding | For example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
238. Claim.procedure | |
Definition | Procedures performed on the patient relevant to the billing items with the claim. |
Short | Clinical procedures performed |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on Claim.procedure . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
240. Claim.procedure.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 10..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on Claim.procedure.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
242. Claim.procedure.extension:serviceDescription | |
Slice Name | serviceDescription |
Definition | This extension is used to communicate a plain language description of the procedure, product, or service. |
Short | Service Description |
Control | 1..1 This element is affected by the following invariants: ele-1 |
Type | Extension(Service Description) (Extension Type: string) |
Is Modifier | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
244. Claim.procedure.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
246. Claim.procedure.sequence | |
Definition | A number to uniquely identify procedure entries. |
Short | Procedure instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
248. Claim.procedure.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Category of Procedure |
Comments | For example: primary, secondary. |
Control | 0..* |
Binding | The codes SHALL be taken from For example codes, see PCT Procedure Type Value Sethttp://hl7.org/fhir/ValueSet/ex-procedure-type (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
250. Claim.procedure.procedure[x] | |
Definition | The code or reference to a Procedure resource which identifies the clinical intervention performed. |
Short | Specific clinical procedure |
Control | 1..1 |
Binding | For example codes, see ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures (example to http://hl7.org/fhir/ValueSet/icd-10-procedures )Example ICD10 Procedure codes. |
Type | Choice of: CodeableConcept, Reference(Procedure) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | This identifies the actual clinical procedure. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
252. Claim.procedure:principal | |
Slice Name | principal |
Definition | Procedures performed on the patient relevant to the billing items with the claim. |
Short | Principal clinical procedure performedClinical procedures performed |
Control | 0..1* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
254. Claim.procedure:principal.extension:serviceDescription | |
Slice Name | serviceDescription |
Definition | This extension is used to communicate a plain language description of the procedure, product, or service. |
Short | Service Description |
Control | 1..1 This element is affected by the following invariants: ele-1 |
Type | Extension(Service Description) (Extension Type: string) |
Is Modifier | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
256. Claim.procedure:principal.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
258. Claim.procedure:principal.sequence | |
Definition | A number to uniquely identify procedure entries. |
Short | Procedure instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to provide a mechanism to link to claim details. |
Pattern Value | 1 |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
260. Claim.procedure:principal.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Category of Procedure |
Comments | For example: primary, secondary. |
Control | 10..1* |
Binding | For example codes, see ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type (example to http://hl7.org/fhir/ValueSet/ex-procedure-type )Example procedure type codes. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
262. Claim.procedure:principal.procedure[x] | |
Definition | The code or reference to a Procedure resource which identifies the clinical intervention performed. |
Short | Specific clinical procedure |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see ICD-10 Procedure Codeshttp://hl7.org/fhir/ValueSet/icd-10-procedures (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes ) |
Type | CodeableConcept, Reference(Procedure) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | This identifies the actual clinical procedure. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
264. Claim.procedure:other | |
Slice Name | other |
Definition | Procedures performed on the patient relevant to the billing items with the claim. |
Short | Clinical procedures performed |
Control | 0..24* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
266. Claim.procedure:other.extension:serviceDescription | |
Slice Name | serviceDescription |
Definition | This extension is used to communicate a plain language description of the procedure, product, or service. |
Short | Service Description |
Control | 1..1 This element is affected by the following invariants: ele-1 |
Type | Extension(Service Description) (Extension Type: string) |
Is Modifier | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
268. Claim.procedure:other.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
270. Claim.procedure:other.sequence | |
Definition | A number to uniquely identify procedure entries. |
Short | Procedure instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
272. Claim.procedure:other.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Category of Procedure |
Comments | For example: primary, secondary. |
Control | 10..1* |
Binding | For example codes, see ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type (example to http://hl7.org/fhir/ValueSet/ex-procedure-type )Example procedure type codes. |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Pattern Value | { |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
274. Claim.procedure:other.procedure[x] | |
Definition | The code or reference to a Procedure resource which identifies the clinical intervention performed. |
Short | Specific clinical procedure |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see PCT CMS HCPCS and AMA CPT Procedure Surgical Codeshttp://hl7.org/fhir/ValueSet/icd-10-procedures (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes ) |
Type | CodeableConcept, Reference(Procedure) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | This identifies the actual clinical procedure. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
276. Claim.insurance | |
Definition | Financial instruments for reimbursement for the health care products and services specified on the claim. |
Short | Patient insurance information |
Comments | All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. |
Control | 1..* |
Type | BackboneElement |
Is Modifier | false |
Summary | true |
Requirements | At least one insurer is required for a claim to be a claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
278. Claim.insurance.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
280. Claim.insurance.sequence | |
Definition | A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order. |
Short | Insurance instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | To maintain order of the coverages. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
282. Claim.insurance.focal | |
Definition | A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. |
Short | Coverage to be used for adjudication |
Comments | A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. |
Control | 1..1 |
Type | boolean |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | To identify which coverage in the list is being used to adjudicate this claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
284. Claim.insurance.coverage | |
Definition | Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. |
Short | Insurance information |
Control | 1..1 |
Type | Reference(PCT Coverage, Coverage) |
Is Modifier | false |
Summary | true |
Requirements | Required to allow the adjudicator to locate the correct policy and history within their information system. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
286. Claim.insurance.coverage.extension:dataAbsentReason | |
Slice Name | dataAbsentReason |
Definition | Provides a reason why the expected value or elements in the element that is extended are missing. |
Short | Coverage may be not applicable if estimate is for self-pay or uninsured |
Control | 0..1 |
Type | Extension(Data Absent Reason) (Extension Type: code) |
Is Modifier | false |
Must Support | true |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
288. Claim.insurance.preAuthRef | |
Definition | Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. |
Short | Prior authorization reference number |
Comments | This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. |
Control | 0..1* |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
290. Claim.item | |
Definition | A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details. |
Short | Product or service provided |
Control | 10..999* |
Type | BackboneElement |
Is Modifier | false |
Summary | false |
Requirements | The items to be processed for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
292. Claim.item.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 10..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on Claim.item.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
294. Claim.item.extension:gfeBillingProviderLineItemCtrlNum | |
Slice Name | gfeBillingProviderLineItemCtrlNum |
Definition | This extension is used by the provider to assign a unique identifier to this item. The intent of this element is to allow the provider to assign something other than 'line number' for their purposes (e.g. tracking and troubleshooting). |
Short | Extension |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | Extension(GFEBillingProviderLineItemCtrlNum) (Extension Type: Identifier) |
Is Modifier | false |
Must Support | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
296. Claim.item.extension:serviceDescription | |
Slice Name | serviceDescription |
Definition | This extension is used to communicate a plain language description of the procedure, product, or service. |
Short | Service Description |
Control | 1..1 This element is affected by the following invariants: ele-1 |
Type | Extension(Service Description) (Extension Type: string) |
Is Modifier | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
298. Claim.item.extension:ProviderEventMethodology | |
Slice Name | ProviderEventMethodology |
Definition | This extension is used for indicating the method a provider used to group services, and those providing such services, beyond what may be indicated through DRGs that the payer or patient may find helpful (e.g. grouping services by a standardized episode of care definition). This is provider generated text and should not be modified by the payer. |
Short | Provider Event Methodology |
Comments | The method a provider used to group services. The extension definition contains additional detail |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | Extension(ProviderEventMethodology) (Extension Type: string) |
Is Modifier | false |
Must Support | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() )ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
300. Claim.item.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
302. Claim.item.sequence | |
Definition | A number to uniquely identify item entries. |
Short | Item instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
304. Claim.item.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Short | Revenue or cost center code - must provide a value for the Institutional case |
Control | 10..1 |
Binding | The codes SHALL be taken from For example codes, see PCT GFE NUBC Revenue Value Sethttp://hl7.org/fhir/ValueSet/ex-revenue-center (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemRevenueVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Needed in the processing of institutional claims. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
306. Claim.item.productOrService | |
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
Short | Billing, service, product, or drug code |
Comments | Can include null or N/A or data absent reason for the In-Patient Institutional case. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see Claim Medical Product or Service Value Sethttp://hl7.org/fhir/ValueSet/service-uscls (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
308. Claim.item.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Short | Product or service billing modifiers |
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. |
Control | 0..4* |
Binding | The codes SHALL be taken from For example codes, see PCT GFE Item CPT - HCPCS Value Sethttp://hl7.org/fhir/ValueSet/claim-modifiers (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
310. Claim.item.serviced[x] | |
Definition | This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication The date or dates when the service or product was supplied, performed or completed. |
Short | This is the planned or estimated date(s)s of serviceDate or dates of service or product delivery |
Control | 10..1 |
Type | Choice of: date, Period |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | true |
Must Support Types | No must-support rules about the choice of types/profiles |
Summary | false |
Requirements | Needed to determine whether the service or product was provided during the term of the insurance coverage. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
312. Claim.item.location[x] | |
Definition | Where the product or service was provided. |
Short | Place of service or where product was supplied |
Control | 0..1 |
Binding | For example codes, see ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-place (example to http://hl7.org/fhir/ValueSet/service-place )Place of service: pharmacy, school, prison, etc. |
Type | Choice of: CodeableConcept, Address, Reference(Location) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Summary | false |
Requirements | The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on Claim.item.location[x] . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
314. Claim.item.location[x]:locationCodeableConcept | |
Slice Name | locationCodeableConcept |
Definition | Where the product or service was provided. |
Short | Place of service or where product was supplied |
Control | 0..1 |
Binding | The codes SHALL be taken from For example codes, see PCT GFE CMS Place of Service Value Sethttp://hl7.org/fhir/ValueSet/service-place (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOS ) |
Type | CodeableConcept, Address, Reference(Location) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
316. Claim.item.quantity | |
Definition | The number of repetitions of a service or product. |
Short | Count of products or services |
Control | 10..1 |
Type | Quantity(SimpleQuantity) |
Is Modifier | false |
Summary | false |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
318. Claim.item.net | |
Definition | The quantity times the unit price for an additional service or product or charge. |
Short | Total charge amount for the service lineTotal item cost |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Control | 10..1 |
Type | Money |
Is Modifier | false |
Summary | false |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
320. Claim.item.detail | |
Definition | A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. |
Short | Drug Identification InformationProduct or service provided |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | The items to be processed for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
322. Claim.item.detail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
324. Claim.item.detail.sequence | |
Definition | A number to uniquely identify item entries. |
Short | Item instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | false |
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
326. Claim.item.detail.productOrService | |
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
Short | Billing, service, product, or drug code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Control | 1..1 |
Binding | The codes SHALL be taken from For example codes, see PCT GFE Item NDC Value Sethttp://hl7.org/fhir/ValueSet/service-uscls (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemNDCVS ) |
Type | CodeableConcept |
Is Modifier | false |
Summary | false |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
328. Claim.item.detail.quantity | |
Definition | The number of repetitions of a service or product. |
Short | Count of products or services |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Is Modifier | false |
Must Support | true |
Summary | false |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
330. Claim.total | |
Definition | The total value of the all the items in the claim. |
Short | Total GFE Charges SubmittedTotal claim cost |
Control | 10..1 |
Type | Money |
Is Modifier | false |
Summary | false |
Requirements | Used for control total purposes. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Guidance on how to interpret the contents of this table can be found here
0. Claim | |||||
Definition | A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement. | ||||
Short | Claim, Pre-determination or Pre-authorization | ||||
Comments | The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services. | ||||
Control | 0..* | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | Adjudication Request, Preauthorization Request, Predetermination Request | ||||
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty() )dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource ( contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() )dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated ( contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() )dom-5: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty() )dom-6: A resource should have narrative for robust management ( text.`div`.exists() ) | ||||
2. Claim.id | |||||
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. | ||||
Short | Logical id of this artifact | ||||
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||||
Control | 0..1 | ||||
Type | id | ||||
Is Modifier | false | ||||
Summary | true | ||||
4. Claim.meta | |||||
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. | ||||
Short | Metadata about the resource | ||||
Control | 0..1 | ||||
Type | Meta | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
6. Claim.implicitRules | |||||
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. | ||||
Short | A set of rules under which this content was created | ||||
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
8. Claim.language | |||||
Definition | The base language in which the resource is written. | ||||
Short | Language of the resource content | ||||
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CommonLanguages (preferred to http://hl7.org/fhir/ValueSet/languages )A human language.
| ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
10. Claim.text | |||||
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. | ||||
Short | Text summary of the resource, for human interpretation | ||||
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. | ||||
Control | 0..1 | ||||
Type | Narrative | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | narrative, html, xhtml, display | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
12. Claim.contained | |||||
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. | ||||
Short | Contained, inline Resources | ||||
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. | ||||
Control | 0..* | ||||
Type | Resource | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | inline resources, anonymous resources, contained resources | ||||
14. Claim.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
16. Claim.extension:gfeServiceLinkingInfo | |||||
Slice Name | gfeServiceLinkingInfo | ||||
Definition | This extension is used to provide the GFE Service Linking Information. This allows implementers to have the same identifier on multiple GFEs that are part of one period of care's services. This would be needed for some of the workflow options that businesses may decide to use. | ||||
Short | GFE Service Linking Information. | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(GFEServiceLinkingInfo) (Complex Extension) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
18. Claim.extension:providerEventMethodology | |||||
Slice Name | providerEventMethodology | ||||
Definition | How the provider determined the number of claims and the number and type of billing providers to include in the GFE. Examples include provider episodes of care experience, PACES, order set based on clinical guidelines, payor suggested grouping, or some other method of determination. The extension definition contains additional detail. | ||||
Short | Provider event collection methodology | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(ProviderEventMethodology) (Extension Type: string) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
20. Claim.extension:gfeDisclaimer | |||||
Slice Name | gfeDisclaimer | ||||
Definition | Disclaimers the patient should be made aware of regarding the providers estimate | ||||
Short | Disclaimers the patient should be made aware of regarding the providers estimate | ||||
Control | 0..* This element is affected by the following invariants: ele-1 | ||||
Type | Extension(GFEDisclaimer) (Extension Type: string) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
22. Claim.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them | ||||
Summary | false | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
24. Claim.identifier | |||||
Definition | A unique identifier assigned to this claim. | ||||
Short | Business Identifier for claim | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 1..* | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Allows claims to be distinguished and referenced. | ||||
Alternate Names | Claim Number | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on Claim.identifier . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
26. Claim.identifier:PLAC | |||||
Slice Name | PLAC | ||||
Definition | A unique identifier assigned to this claim. | ||||
Short | Provider Assigned Identifier for GFE Claim | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 1..1 | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Allows claims to be distinguished and referenced. | ||||
Alternate Names | Claim Number | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
28. Claim.identifier:PLAC.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
30. Claim.identifier:PLAC.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.identifier.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
32. Claim.identifier:PLAC.use | |||||
Definition | The purpose of this identifier. | ||||
Short | usual | official | temp | secondary | old (If known) | ||||
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from IdentifierUse (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 )Identifies the purpose for this identifier, if known . | ||||
Type | code | ||||
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
34. Claim.identifier:PLAC.type | |||||
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Short | Description of identifier | ||||
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Identifier Type Codes (extensible to http://hl7.org/fhir/ValueSet/identifier-type )A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Allows users to make use of identifiers when the identifier system is not known. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
36. Claim.identifier:PLAC.system | |||||
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. | ||||
Short | The namespace for the identifier value | ||||
Comments | Identifier.system is always case sensitive. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. | ||||
Example | <br/><b>General</b>:http://www.acme.com/identifiers/patient | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
38. Claim.identifier:PLAC.value | |||||
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. | ||||
Short | The value that is unique | ||||
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. | ||||
Control | 1..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Example | <br/><b>General</b>:123456 | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
40. Claim.identifier:PLAC.period | |||||
Definition | Time period during which identifier is/was valid for use. | ||||
Short | Time period when id is/was valid for use | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
42. Claim.identifier:PLAC.assigner | |||||
Definition | Organization that issued/manages the identifier. | ||||
Short | Organization that issued id (may be just text) | ||||
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. | ||||
Control | 0..1 | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
44. Claim.identifier:INTER | |||||
Slice Name | INTER | ||||
Definition | A unique identifier assigned to this claim. | ||||
Short | Intermediary System Identifier | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..* | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Allows claims to be distinguished and referenced. | ||||
Alternate Names | Claim Number | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
46. Claim.identifier:INTER.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
48. Claim.identifier:INTER.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.identifier.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
50. Claim.identifier:INTER.use | |||||
Definition | The purpose of this identifier. | ||||
Short | usual | official | temp | secondary | old (If known) | ||||
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from IdentifierUse (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 )Identifies the purpose for this identifier, if known . | ||||
Type | code | ||||
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
52. Claim.identifier:INTER.type | |||||
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Short | Description of identifier | ||||
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from Identifier Type Codes (extensible to http://hl7.org/fhir/ValueSet/identifier-type )A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Allows users to make use of identifiers when the identifier system is not known. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
54. Claim.identifier:INTER.system | |||||
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. | ||||
Short | The namespace for the identifier value | ||||
Comments | Identifier.system is always case sensitive. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. | ||||
Example | <br/><b>General</b>:http://www.acme.com/identifiers/patient | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
56. Claim.identifier:INTER.value | |||||
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. | ||||
Short | The value that is unique | ||||
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Example | <br/><b>General</b>:123456 | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
58. Claim.identifier:INTER.period | |||||
Definition | Time period during which identifier is/was valid for use. | ||||
Short | Time period when id is/was valid for use | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
60. Claim.identifier:INTER.assigner | |||||
Definition | Organization that issued/manages the identifier. | ||||
Short | Organization that issued id (may be just text) | ||||
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. | ||||
Control | 0..1 | ||||
Type | Reference(Organization) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
62. Claim.status | |||||
Definition | The status of the resource instance. | ||||
Short | active | cancelled | draft | entered-in-error | ||||
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from FinancialResourceStatusCodes (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1 )A code specifying the state of the resource instance. | ||||
Type | code | ||||
Is Modifier | true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
64. Claim.type | |||||
Definition | The category of claim, e.g. oral, pharmacy, vision, institutional, professional. | ||||
Short | Category or discipline | ||||
Comments | The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements. | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from ClaimTypeCodes (extensible to http://hl7.org/fhir/ValueSet/claim-type )The type or discipline-style of the claim. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Claim type determine the general sets of business rules applied for information requirements and adjudication. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
66. Claim.subType | |||||
Definition | A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. | ||||
Short | More granular claim type | ||||
Comments | This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleClaimSubTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-subtype )A more granular claim typecode. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Some jurisdictions need a finer grained claim type for routing and adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
68. Claim.use | |||||
Definition | A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future. | ||||
Short | claim | preauthorization | predetermination | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from Use (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1 )The purpose of the Claim: predetermination, preauthorization, claim. | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | This element is required to understand the nature of the request for adjudication. | ||||
Pattern Value | predetermination | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
70. Claim.patient | |||||
Definition | The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought. | ||||
Short | The recipient of the products and services | ||||
Control | 1..1 | ||||
Type | Reference(HRex Patient Demographics) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
72. Claim.billablePeriod | |||||
Definition | The period for which charges are being submitted. | ||||
Short | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims. | ||||
Comments | Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified. | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Requirements | A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
74. Claim.created | |||||
Definition | The date this resource was created. | ||||
Short | Resource creation date | ||||
Comments | This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. | ||||
Control | 1..1 | ||||
Type | dateTime | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Need to record a timestamp for use by both the recipient and the issuer. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
76. Claim.enterer | |||||
Definition | Individual who created the claim, predetermination or preauthorization. | ||||
Short | Author of the claim | ||||
Control | 0..1 | ||||
Type | Reference(Practitioner, PractitionerRole) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Some jurisdictions require the contact information for personnel completing claims. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
78. Claim.insurer | |||||
Definition | The Insurer who is target of the request. | ||||
Short | Required if insured estimate | ||||
Control | 0..1 | ||||
Type | Reference(PCT Organization) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
80. Claim.provider | |||||
Definition | The provider which is responsible for the claim, predetermination or preauthorization. | ||||
Short | Billing provider - party responsible for the GFE | ||||
Comments | Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. | ||||
Control | 1..1 | ||||
Type | Reference(PCT Organization) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
82. Claim.provider.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
84. Claim.provider.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 1..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.provider.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
86. Claim.provider.extension:providerTaxonomy | |||||
Slice Name | providerTaxonomy | ||||
Definition | This extension is used to indicate the taxonomy code of the provider. | ||||
Short | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers | ||||
Control | 1..1 | ||||
Type | Extension(ProviderTaxonomy) (Extension Type: CodeableConcept) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
88. Claim.provider.extension:consentForBalanceBilling | |||||
Slice Name | consentForBalanceBilling | ||||
Definition | If the provider has received a written consent form indicating a patient has agreed to waive their protections and pay up to the full cost for the out-of-network item or service, this will be “true”. If the provider has not received written consent, this will be “false”. This is an attestation only. The billing provider is legally required to maintain the written notice and consent form. | ||||
Short | Extension | ||||
Control | 0..1 | ||||
Type | Extension(GFEConsentForBalanceBilling) (Extension Type: boolean) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
90. Claim.provider.reference | |||||
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
Short | Literal reference, Relative, internal or absolute URL | ||||
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
92. Claim.provider.type | |||||
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). | ||||
Short | Type the reference refers to (e.g. "Patient") | ||||
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to http://hl7.org/fhir/ValueSet/resource-types )Aa resource (or, for logical models, the URI of the logical model). | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
94. Claim.provider.identifier | |||||
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
Short | Logical reference, when literal reference is not known | ||||
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..1 | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
96. Claim.provider.display | |||||
Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
Short | Text alternative for the resource | ||||
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
98. Claim.priority | |||||
Definition | The provider-required urgency of processing the request. Typical values include: stat, routine deferred. | ||||
Short | Desired processing ugency | ||||
Comments | If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from ProcessPriorityCodes (required to http://hl7.org/fhir/ValueSet/process-priority ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
100. Claim.fundsReserve | |||||
Definition | A code to indicate whether and for whom funds are to be reserved for future claims. | ||||
Short | For whom to reserve funds | ||||
Comments | This field is only used for preauthorizations. | ||||
Control | 0..1 | ||||
Binding | For example codes, see Funds Reservation Codes (example to http://hl7.org/fhir/ValueSet/fundsreserve )For whom funds are to be reserved: (Patient, Provider, None). | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested. | ||||
Alternate Names | Fund pre-allocation | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
102. Claim.related | |||||
Definition | Other claims which are related to this claim such as prior submissions or claims for related services or for the same event. | ||||
Short | Prior or corollary claims | ||||
Comments | For example, for the original treatment and follow-up exams. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | For workplace or other accidents it is common to relate separate claims arising from the same event. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
104. Claim.related.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
106. Claim.related.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
108. Claim.related.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
110. Claim.related.claim | |||||
Definition | Reference to a related claim. | ||||
Short | Reference to the related claim | ||||
Control | 0..1 | ||||
Type | Reference(Claim) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | For workplace or other accidents it is common to relate separate claims arising from the same event. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
112. Claim.related.relationship | |||||
Definition | A code to convey how the claims are related. | ||||
Short | How the reference claim is related | ||||
Comments | For example, prior claim or umbrella. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleRelatedClaimRelationshipCodes (example to http://hl7.org/fhir/ValueSet/related-claim-relationship )Relationship of this claim to a related Claim. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Some insurers need a declaration of the type of relationship. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
114. Claim.related.reference | |||||
Definition | An alternate organizational reference to the case or file to which this particular claim pertains. | ||||
Short | File or case reference | ||||
Comments | For example, Property/Casualty insurer claim # or Workers Compensation case # . | ||||
Control | 0..1 | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
116. Claim.prescription | |||||
Definition | Prescription to support the dispensing of pharmacy, device or vision products. | ||||
Short | Prescription authorizing services and products | ||||
Control | 0..1 | ||||
Type | Reference(DeviceRequest, MedicationRequest, VisionPrescription) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to authorize the dispensing of controlled substances and devices. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
118. Claim.originalPrescription | |||||
Definition | Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. | ||||
Short | Original prescription if superseded by fulfiller | ||||
Comments | For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'. | ||||
Control | 0..1 | ||||
Type | Reference(DeviceRequest, MedicationRequest, VisionPrescription) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
120. Claim.payee | |||||
Definition | The party to be reimbursed for cost of the products and services according to the terms of the policy. | ||||
Short | Recipient of benefits payable | ||||
Comments | Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
122. Claim.payee.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
124. Claim.payee.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
126. Claim.payee.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
128. Claim.payee.type | |||||
Definition | Type of Party to be reimbursed: subscriber, provider, other. | ||||
Short | Category of recipient | ||||
Control | 1..1 | ||||
Binding | For example codes, see Claim Payee Type Codes (example to http://hl7.org/fhir/ValueSet/payeetype )A code for the party to be reimbursed. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
130. Claim.payee.party | |||||
Definition | Reference to the individual or organization to whom any payment will be made. | ||||
Short | Recipient reference | ||||
Comments | Not required if the payee is 'subscriber' or 'provider'. | ||||
Control | 0..1 | ||||
Type | Reference(PCT Practitioner, PCT Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to provide demographics if the payee is not 'subscriber' nor 'provider'. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
132. Claim.referral | |||||
Definition | A reference to a referral resource. | ||||
Short | Treatment referral | ||||
Comments | The referral resource which lists the date, practitioner, reason and other supporting information. | ||||
Control | 0..1 | ||||
Type | Reference(ServiceRequest) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Some insurers require proof of referral to pay for services or to pay specialist rates for services. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
134. Claim.referral.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
136. Claim.referral.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 1..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.referral.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
138. Claim.referral.extension:referralNumber | |||||
Slice Name | referralNumber | ||||
Definition | This extension is used to provide the Referral Number. | ||||
Short | Referral Number | ||||
Control | 1..1 | ||||
Type | Extension(ReferralNumber) (Extension Type: string) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
140. Claim.referral.reference | |||||
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
Short | Literal reference, Relative, internal or absolute URL | ||||
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
142. Claim.referral.type | |||||
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). | ||||
Short | Type the reference refers to (e.g. "Patient") | ||||
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to http://hl7.org/fhir/ValueSet/resource-types )Aa resource (or, for logical models, the URI of the logical model). | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
144. Claim.referral.identifier | |||||
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
Short | Logical reference, when literal reference is not known | ||||
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..1 | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
146. Claim.referral.display | |||||
Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
Short | Text alternative for the resource | ||||
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
148. Claim.facility | |||||
Definition | Facility where the services were provided. | ||||
Short | Servicing facility | ||||
Control | 0..1 | ||||
Type | Reference(Location) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Insurance adjudication can be dependant on where services were delivered. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
150. Claim.careTeam | |||||
Definition | The members of the team who provided the products and services. | ||||
Short | Members of the care team | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Common to identify the responsible and supporting practitioners. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on Claim.careTeam . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
152. Claim.careTeam.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
154. Claim.careTeam.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
156. Claim.careTeam.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
158. Claim.careTeam.sequence | |||||
Definition | A number to uniquely identify care team entries. | ||||
Short | Order of care team | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
160. Claim.careTeam.provider | |||||
Definition | Member of the team who provided the product or service. | ||||
Short | Practitioner or organization | ||||
Control | 1..1 | ||||
Type | Reference(PCT Practitioner, PCT Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often a regulatory requirement to specify the responsible provider. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
162. Claim.careTeam.responsible | |||||
Definition | The party who is billing and/or responsible for the claimed products or services. | ||||
Short | Indicator of the lead practitioner | ||||
Comments | Responsible might not be required when there is only a single provider listed. | ||||
Control | 0..1 | ||||
Type | boolean | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the lead or responsible individual. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
164. Claim.careTeam.role | |||||
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. | ||||
Short | Function within the team | ||||
Comments | Role might not be required when there is only a single provider listed. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT Care Team Role Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
166. Claim.careTeam.qualification | |||||
Definition | The qualification of the practitioner which is applicable for this service. | ||||
Short | Practitioner credential or specialization | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from US Core Provider Role (NUCC) (required to http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to specify which qualification a provider is delivering the product or service under. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
168. Claim.careTeam:attending | |||||
Slice Name | attending | ||||
Definition | The members of the team who provided the products and services. | ||||
Short | Members of the care team | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Common to identify the responsible and supporting practitioners. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
170. Claim.careTeam:attending.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
172. Claim.careTeam:attending.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
174. Claim.careTeam:attending.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
176. Claim.careTeam:attending.sequence | |||||
Definition | A number to uniquely identify care team entries. | ||||
Short | Order of care team | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
178. Claim.careTeam:attending.provider | |||||
Definition | Member of the team who provided the product or service. | ||||
Short | Practitioner or organization | ||||
Control | 1..1 | ||||
Type | Reference(PCT Practitioner) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often a regulatory requirement to specify the responsible provider. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
180. Claim.careTeam:attending.responsible | |||||
Definition | The party who is billing and/or responsible for the claimed products or services. | ||||
Short | Indicator of the lead practitioner | ||||
Comments | Responsible might not be required when there is only a single provider listed. | ||||
Control | 0..1 | ||||
Type | boolean | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the lead or responsible individual. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
182. Claim.careTeam:attending.role | |||||
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. | ||||
Short | Function within the team | ||||
Comments | Role might not be required when there is only a single provider listed. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ClaimCareTeamRoleCodes (example to http://hl7.org/fhir/ValueSet/claim-careteamrole )The role codes for the care team members. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
184. Claim.careTeam:attending.qualification | |||||
Definition | The qualification of the practitioner which is applicable for this service. | ||||
Short | Practitioner credential or specialization | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleProviderQualificationCodes (example to http://hl7.org/fhir/ValueSet/provider-qualification )Provider professional qualifications. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to specify which qualification a provider is delivering the product or service under. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
186. Claim.careTeam:operating | |||||
Slice Name | operating | ||||
Definition | The members of the team who provided the products and services. | ||||
Short | Members of the care team | ||||
Control | 0..2 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Common to identify the responsible and supporting practitioners. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
188. Claim.careTeam:operating.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
190. Claim.careTeam:operating.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
192. Claim.careTeam:operating.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
194. Claim.careTeam:operating.sequence | |||||
Definition | A number to uniquely identify care team entries. | ||||
Short | Order of care team | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
196. Claim.careTeam:operating.provider | |||||
Definition | Member of the team who provided the product or service. | ||||
Short | Practitioner or organization | ||||
Control | 1..1 | ||||
Type | Reference(PCT Practitioner) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often a regulatory requirement to specify the responsible provider. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
198. Claim.careTeam:operating.responsible | |||||
Definition | The party who is billing and/or responsible for the claimed products or services. | ||||
Short | Indicator of the lead practitioner | ||||
Comments | Responsible might not be required when there is only a single provider listed. | ||||
Control | 0..1 | ||||
Type | boolean | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the lead or responsible individual. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
200. Claim.careTeam:operating.role | |||||
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. | ||||
Short | Function within the team | ||||
Comments | Role might not be required when there is only a single provider listed. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ClaimCareTeamRoleCodes (example to http://hl7.org/fhir/ValueSet/claim-careteamrole )The role codes for the care team members. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
202. Claim.careTeam:operating.qualification | |||||
Definition | The qualification of the practitioner which is applicable for this service. | ||||
Short | Practitioner credential or specialization | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleProviderQualificationCodes (example to http://hl7.org/fhir/ValueSet/provider-qualification )Provider professional qualifications. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to specify which qualification a provider is delivering the product or service under. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
204. Claim.careTeam:rendering | |||||
Slice Name | rendering | ||||
Definition | The members of the team who provided the products and services. | ||||
Short | Members of the care team | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Common to identify the responsible and supporting practitioners. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
206. Claim.careTeam:rendering.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
208. Claim.careTeam:rendering.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
210. Claim.careTeam:rendering.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
212. Claim.careTeam:rendering.sequence | |||||
Definition | A number to uniquely identify care team entries. | ||||
Short | Order of care team | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
214. Claim.careTeam:rendering.provider | |||||
Definition | Member of the team who provided the product or service. | ||||
Short | Practitioner or organization | ||||
Control | 1..1 | ||||
Type | Reference(PCT Practitioner) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often a regulatory requirement to specify the responsible provider. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
216. Claim.careTeam:rendering.responsible | |||||
Definition | The party who is billing and/or responsible for the claimed products or services. | ||||
Short | Indicator of the lead practitioner | ||||
Comments | Responsible might not be required when there is only a single provider listed. | ||||
Control | 0..1 | ||||
Type | boolean | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the lead or responsible individual. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
218. Claim.careTeam:rendering.role | |||||
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. | ||||
Short | Function within the team | ||||
Comments | Role might not be required when there is only a single provider listed. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ClaimCareTeamRoleCodes (example to http://hl7.org/fhir/ValueSet/claim-careteamrole )The role codes for the care team members. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
220. Claim.careTeam:rendering.qualification | |||||
Definition | The qualification of the practitioner which is applicable for this service. | ||||
Short | Practitioner credential or specialization | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleProviderQualificationCodes (example to http://hl7.org/fhir/ValueSet/provider-qualification )Provider professional qualifications. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to specify which qualification a provider is delivering the product or service under. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
222. Claim.careTeam:referring | |||||
Slice Name | referring | ||||
Definition | The members of the team who provided the products and services. | ||||
Short | Members of the care team | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Common to identify the responsible and supporting practitioners. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
224. Claim.careTeam:referring.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
226. Claim.careTeam:referring.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
228. Claim.careTeam:referring.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
230. Claim.careTeam:referring.sequence | |||||
Definition | A number to uniquely identify care team entries. | ||||
Short | Order of care team | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
232. Claim.careTeam:referring.provider | |||||
Definition | Member of the team who provided the product or service. | ||||
Short | Practitioner or organization | ||||
Control | 1..1 | ||||
Type | Reference(Practitioner, PractitionerRole, Organization) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often a regulatory requirement to specify the responsible provider. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
234. Claim.careTeam:referring.responsible | |||||
Definition | The party who is billing and/or responsible for the claimed products or services. | ||||
Short | Indicator of the lead practitioner | ||||
Comments | Responsible might not be required when there is only a single provider listed. | ||||
Control | 0..1 | ||||
Type | boolean | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the lead or responsible individual. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
236. Claim.careTeam:referring.role | |||||
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. | ||||
Short | Function within the team | ||||
Comments | Role might not be required when there is only a single provider listed. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ClaimCareTeamRoleCodes (example to http://hl7.org/fhir/ValueSet/claim-careteamrole )The role codes for the care team members. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
238. Claim.careTeam:referring.qualification | |||||
Definition | The qualification of the practitioner which is applicable for this service. | ||||
Short | Practitioner credential or specialization | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleProviderQualificationCodes (example to http://hl7.org/fhir/ValueSet/provider-qualification )Provider professional qualifications. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Need to specify which qualification a provider is delivering the product or service under. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
240. Claim.supportingInfo | |||||
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. | ||||
Short | Supporting information | ||||
Comments | Often there are multiple jurisdiction specific valuesets which are required. | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. | ||||
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on Claim.supportingInfo . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
242. Claim.supportingInfo.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
244. Claim.supportingInfo.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
246. Claim.supportingInfo.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
248. Claim.supportingInfo.sequence | |||||
Definition | A number to uniquely identify supporting information entries. | ||||
Short | Information instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
250. Claim.supportingInfo.category | |||||
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. | ||||
Short | Classification of the supplied information | ||||
Comments | This may contain a category for the local bill type codes. | ||||
Control | 1..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from PCT Supporting Info Type Value Set (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
252. Claim.supportingInfo.code | |||||
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. | ||||
Short | Type of information | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExceptionCodes (example to http://hl7.org/fhir/ValueSet/claim-exception )The valuset used for additional information codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to identify the kind of additional information. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
254. Claim.supportingInfo.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Short | When it occurred | ||||
Control | 0..1 | ||||
Type | Choice of: date, Period | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
256. Claim.supportingInfo.value[x] | |||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Short | Data to be provided | ||||
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. | ||||
Control | 0..1 | ||||
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | To convey the data content to be provided when the information is more than a simple code or period. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
258. Claim.supportingInfo.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Short | Explanation for the information | ||||
Comments | For example: the reason for the additional stay, or why a tooth is missing. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason )Reason codes for the missing teeth. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
260. Claim.supportingInfo:typeOfBill | |||||
Slice Name | typeOfBill | ||||
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. | ||||
Short | Supporting information | ||||
Comments | Often there are multiple jurisdiction specific valuesets which are required. | ||||
Control | 1..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. | ||||
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
262. Claim.supportingInfo:typeOfBill.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
264. Claim.supportingInfo:typeOfBill.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
266. Claim.supportingInfo:typeOfBill.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
268. Claim.supportingInfo:typeOfBill.sequence | |||||
Definition | A number to uniquely identify supporting information entries. | ||||
Short | Information instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
270. Claim.supportingInfo:typeOfBill.category | |||||
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. | ||||
Short | Classification of the supplied information | ||||
Comments | This may contain a category for the local bill type codes. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ClaimInformationCategoryCodes (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
272. Claim.supportingInfo:typeOfBill.code | |||||
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. | ||||
Short | Type of information | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFETypeOfBillVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to identify the kind of additional information. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
274. Claim.supportingInfo:typeOfBill.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Short | When it occurred | ||||
Control | 0..1 | ||||
Type | Choice of: date, Period | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
276. Claim.supportingInfo:typeOfBill.value[x] | |||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Short | Data to be provided | ||||
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. | ||||
Control | 0..1 | ||||
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | To convey the data content to be provided when the information is more than a simple code or period. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
278. Claim.supportingInfo:typeOfBill.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Short | Explanation for the information | ||||
Comments | For example: the reason for the additional stay, or why a tooth is missing. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason )Reason codes for the missing teeth. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
280. Claim.supportingInfo:serviceFacility | |||||
Slice Name | serviceFacility | ||||
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. | ||||
Short | Service Facility | ||||
Comments | Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. | ||||
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
282. Claim.supportingInfo:serviceFacility.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
284. Claim.supportingInfo:serviceFacility.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
286. Claim.supportingInfo:serviceFacility.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
288. Claim.supportingInfo:serviceFacility.sequence | |||||
Definition | A number to uniquely identify supporting information entries. | ||||
Short | Information instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
290. Claim.supportingInfo:serviceFacility.category | |||||
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. | ||||
Short | Classification of the supplied information | ||||
Comments | This may contain a category for the local bill type codes. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ClaimInformationCategoryCodes (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
292. Claim.supportingInfo:serviceFacility.code | |||||
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. | ||||
Short | Type of information | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExceptionCodes (example to http://hl7.org/fhir/ValueSet/claim-exception )The valuset used for additional information codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to identify the kind of additional information. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
294. Claim.supportingInfo:serviceFacility.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Short | When it occurred | ||||
Control | 0..1 | ||||
Type | Choice of: date, Period | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
296. Claim.supportingInfo:serviceFacility.value[x] | |||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Short | Data to be provided | ||||
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. | ||||
Control | 1..1 | ||||
Type | Reference(Resource) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | To convey the data content to be provided when the information is more than a simple code or period. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on Claim.supportingInfo.value[x] . The slices areUnordered and Closed, and can be differentiated using the following discriminators: | ||||
298. Claim.supportingInfo:serviceFacility.value[x]:valueReference | |||||
Slice Name | valueReference | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Short | Data to be provided | ||||
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. | ||||
Control | 1..1 | ||||
Type | Reference(PCT Organization) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | To convey the data content to be provided when the information is more than a simple code or period. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
300. Claim.supportingInfo:serviceFacility.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Short | Explanation for the information | ||||
Comments | For example: the reason for the additional stay, or why a tooth is missing. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason )Reason codes for the missing teeth. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
302. Claim.supportingInfo:drg | |||||
Slice Name | drg | ||||
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. | ||||
Short | Supporting information | ||||
Comments | Often there are multiple jurisdiction specific valuesets which are required. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. | ||||
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
304. Claim.supportingInfo:drg.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
306. Claim.supportingInfo:drg.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
308. Claim.supportingInfo:drg.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
310. Claim.supportingInfo:drg.sequence | |||||
Definition | A number to uniquely identify supporting information entries. | ||||
Short | Information instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
312. Claim.supportingInfo:drg.category | |||||
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. | ||||
Short | Classification of the supplied information | ||||
Comments | This may contain a category for the local bill type codes. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ClaimInformationCategoryCodes (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
314. Claim.supportingInfo:drg.code | |||||
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. | ||||
Short | Type of information | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from US Claim DRG Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimDRGCodes ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to identify the kind of additional information. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
316. Claim.supportingInfo:drg.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Short | When it occurred | ||||
Control | 0..1 | ||||
Type | Choice of: date, Period | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
318. Claim.supportingInfo:drg.value[x] | |||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Short | Data to be provided | ||||
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. | ||||
Control | 0..1 | ||||
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | To convey the data content to be provided when the information is more than a simple code or period. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
320. Claim.supportingInfo:drg.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Short | Explanation for the information | ||||
Comments | For example: the reason for the additional stay, or why a tooth is missing. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason )Reason codes for the missing teeth. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
322. Claim.supportingInfo:pointoforigin | |||||
Slice Name | pointoforigin | ||||
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. | ||||
Short | Supporting information | ||||
Comments | Often there are multiple jurisdiction specific valuesets which are required. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. | ||||
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
324. Claim.supportingInfo:pointoforigin.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
326. Claim.supportingInfo:pointoforigin.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
328. Claim.supportingInfo:pointoforigin.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
330. Claim.supportingInfo:pointoforigin.sequence | |||||
Definition | A number to uniquely identify supporting information entries. | ||||
Short | Information instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
332. Claim.supportingInfo:pointoforigin.category | |||||
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. | ||||
Short | Classification of the supplied information | ||||
Comments | This may contain a category for the local bill type codes. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ClaimInformationCategoryCodes (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
334. Claim.supportingInfo:pointoforigin.code | |||||
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. | ||||
Short | Type of information | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from NUBC Point Of Origin (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPointOfOriginVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to identify the kind of additional information. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
336. Claim.supportingInfo:pointoforigin.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Short | When it occurred | ||||
Control | 0..1 | ||||
Type | Choice of: date, Period | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
338. Claim.supportingInfo:pointoforigin.value[x] | |||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Short | Data to be provided | ||||
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. | ||||
Control | 0..1 | ||||
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | To convey the data content to be provided when the information is more than a simple code or period. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
340. Claim.supportingInfo:pointoforigin.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Short | Explanation for the information | ||||
Comments | For example: the reason for the additional stay, or why a tooth is missing. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason )Reason codes for the missing teeth. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
342. Claim.supportingInfo:admtype | |||||
Slice Name | admtype | ||||
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. | ||||
Short | Supporting information | ||||
Comments | Often there are multiple jurisdiction specific valuesets which are required. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. | ||||
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
344. Claim.supportingInfo:admtype.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
346. Claim.supportingInfo:admtype.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
348. Claim.supportingInfo:admtype.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
350. Claim.supportingInfo:admtype.sequence | |||||
Definition | A number to uniquely identify supporting information entries. | ||||
Short | Information instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
352. Claim.supportingInfo:admtype.category | |||||
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. | ||||
Short | Classification of the supplied information | ||||
Comments | This may contain a category for the local bill type codes. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ClaimInformationCategoryCodes (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
354. Claim.supportingInfo:admtype.code | |||||
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. | ||||
Short | Type of information | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from NUBC Priority (Type) of Admission or Visit (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisitVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to identify the kind of additional information. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
356. Claim.supportingInfo:admtype.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Short | When it occurred | ||||
Control | 0..1 | ||||
Type | Choice of: date, Period | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
358. Claim.supportingInfo:admtype.value[x] | |||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Short | Data to be provided | ||||
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. | ||||
Control | 0..1 | ||||
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | To convey the data content to be provided when the information is more than a simple code or period. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
360. Claim.supportingInfo:admtype.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Short | Explanation for the information | ||||
Comments | For example: the reason for the additional stay, or why a tooth is missing. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason )Reason codes for the missing teeth. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
362. Claim.diagnosis | |||||
Definition | Information about diagnoses relevant to the claim items. | ||||
Short | Pertinent diagnosis information | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Required for the adjudication by provided context for the services and product listed. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on Claim.diagnosis . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
364. Claim.diagnosis.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
366. Claim.diagnosis.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
368. Claim.diagnosis.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
370. Claim.diagnosis.sequence | |||||
Definition | A number to uniquely identify diagnosis entries. | ||||
Short | Diagnosis instance identifier | ||||
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
372. Claim.diagnosis.diagnosis[x] | |||||
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. | ||||
Short | Nature of illness or problem | ||||
Control | 1..1 | ||||
Binding | For example codes, see ICD-10Codes (example to http://hl7.org/fhir/ValueSet/icd-10 )Example ICD10 Diagnostic codes. | ||||
Type | Choice of: CodeableConcept, Reference(Condition) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Provides health context for the evaluation of the products and/or services. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
374. Claim.diagnosis.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Short | Timing or nature of the diagnosis | ||||
Comments | For example: admitting, primary, secondary, discharge. | ||||
Control | 0..* | ||||
Binding | The codes SHALL be taken from PCT Diagnosis Type Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
376. Claim.diagnosis.onAdmission | |||||
Definition | Indication of whether the diagnosis was present on admission to a facility. | ||||
Short | Present on admission | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisOnAdmissionCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission )Present on admission. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Many systems need to understand for adjudication if the diagnosis was present a time of admission. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
378. Claim.diagnosis.packageCode | |||||
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. | ||||
Short | Package billing code | ||||
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisRelatedGroupCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup )The DRG codes associated with the diagnosis. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
380. Claim.diagnosis:principal | |||||
Slice Name | principal | ||||
Definition | Information about diagnoses relevant to the claim items. | ||||
Short | Pertinent diagnosis information | ||||
Control | 1..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required for the adjudication by provided context for the services and product listed. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
382. Claim.diagnosis:principal.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
384. Claim.diagnosis:principal.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
386. Claim.diagnosis:principal.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
388. Claim.diagnosis:principal.sequence | |||||
Definition | A number to uniquely identify diagnosis entries. | ||||
Short | Diagnosis instance identifier | ||||
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. | ||||
Pattern Value | 1 | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
390. Claim.diagnosis:principal.diagnosis[x] | |||||
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. | ||||
Short | Nature of illness or problem | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) | ||||
Type | CodeableConcept | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Provides health context for the evaluation of the products and/or services. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
392. Claim.diagnosis:principal.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Short | Timing or nature of the diagnosis | ||||
Comments | For example: admitting, primary, secondary, discharge. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleDiagnosisTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
394. Claim.diagnosis:principal.onAdmission | |||||
Definition | Indication of whether the diagnosis was present on admission to a facility. | ||||
Short | Present on admission | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisOnAdmissionCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission )Present on admission. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Many systems need to understand for adjudication if the diagnosis was present a time of admission. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
396. Claim.diagnosis:principal.packageCode | |||||
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. | ||||
Short | Package billing code | ||||
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisRelatedGroupCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup )The DRG codes associated with the diagnosis. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
398. Claim.diagnosis:admitting | |||||
Slice Name | admitting | ||||
Definition | Information about diagnoses relevant to the claim items. | ||||
Short | Pertinent diagnosis information | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Required for the adjudication by provided context for the services and product listed. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
400. Claim.diagnosis:admitting.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
402. Claim.diagnosis:admitting.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
404. Claim.diagnosis:admitting.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
406. Claim.diagnosis:admitting.sequence | |||||
Definition | A number to uniquely identify diagnosis entries. | ||||
Short | Diagnosis instance identifier | ||||
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
408. Claim.diagnosis:admitting.diagnosis[x] | |||||
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. | ||||
Short | Nature of illness or problem | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) | ||||
Type | CodeableConcept | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Provides health context for the evaluation of the products and/or services. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
410. Claim.diagnosis:admitting.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Short | Timing or nature of the diagnosis | ||||
Comments | For example: admitting, primary, secondary, discharge. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleDiagnosisTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
412. Claim.diagnosis:admitting.onAdmission | |||||
Definition | Indication of whether the diagnosis was present on admission to a facility. | ||||
Short | Present on admission | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisOnAdmissionCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission )Present on admission. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Many systems need to understand for adjudication if the diagnosis was present a time of admission. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
414. Claim.diagnosis:admitting.packageCode | |||||
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. | ||||
Short | Package billing code | ||||
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisRelatedGroupCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup )The DRG codes associated with the diagnosis. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
416. Claim.diagnosis:patientReasonForVisit | |||||
Slice Name | patientReasonForVisit | ||||
Definition | Information about diagnoses relevant to the claim items. | ||||
Short | Pertinent diagnosis information | ||||
Control | 0..3 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Required for the adjudication by provided context for the services and product listed. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
418. Claim.diagnosis:patientReasonForVisit.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
420. Claim.diagnosis:patientReasonForVisit.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
422. Claim.diagnosis:patientReasonForVisit.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
424. Claim.diagnosis:patientReasonForVisit.sequence | |||||
Definition | A number to uniquely identify diagnosis entries. | ||||
Short | Diagnosis instance identifier | ||||
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
426. Claim.diagnosis:patientReasonForVisit.diagnosis[x] | |||||
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. | ||||
Short | Nature of illness or problem | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) | ||||
Type | CodeableConcept | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Provides health context for the evaluation of the products and/or services. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
428. Claim.diagnosis:patientReasonForVisit.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Short | Timing or nature of the diagnosis | ||||
Comments | For example: admitting, primary, secondary, discharge. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleDiagnosisTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
430. Claim.diagnosis:patientReasonForVisit.onAdmission | |||||
Definition | Indication of whether the diagnosis was present on admission to a facility. | ||||
Short | Present on admission | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisOnAdmissionCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission )Present on admission. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Many systems need to understand for adjudication if the diagnosis was present a time of admission. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
432. Claim.diagnosis:patientReasonForVisit.packageCode | |||||
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. | ||||
Short | Package billing code | ||||
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisRelatedGroupCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup )The DRG codes associated with the diagnosis. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
434. Claim.diagnosis:externalcauseofinjury | |||||
Slice Name | externalcauseofinjury | ||||
Definition | Information about diagnoses relevant to the claim items. | ||||
Short | Pertinent diagnosis information | ||||
Control | 0..12 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Required for the adjudication by provided context for the services and product listed. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
436. Claim.diagnosis:externalcauseofinjury.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
438. Claim.diagnosis:externalcauseofinjury.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
440. Claim.diagnosis:externalcauseofinjury.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
442. Claim.diagnosis:externalcauseofinjury.sequence | |||||
Definition | A number to uniquely identify diagnosis entries. | ||||
Short | Diagnosis instance identifier | ||||
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
444. Claim.diagnosis:externalcauseofinjury.diagnosis[x] | |||||
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. | ||||
Short | Nature of illness or problem | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) | ||||
Type | CodeableConcept | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Provides health context for the evaluation of the products and/or services. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
446. Claim.diagnosis:externalcauseofinjury.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Short | Timing or nature of the diagnosis | ||||
Comments | For example: admitting, primary, secondary, discharge. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleDiagnosisTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
448. Claim.diagnosis:externalcauseofinjury.onAdmission | |||||
Definition | Indication of whether the diagnosis was present on admission to a facility. | ||||
Short | Present on admission | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisOnAdmissionCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission )Present on admission. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Many systems need to understand for adjudication if the diagnosis was present a time of admission. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
450. Claim.diagnosis:externalcauseofinjury.packageCode | |||||
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. | ||||
Short | Package billing code | ||||
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisRelatedGroupCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup )The DRG codes associated with the diagnosis. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
452. Claim.diagnosis:other | |||||
Slice Name | other | ||||
Definition | Information about diagnoses relevant to the claim items. | ||||
Short | Pertinent diagnosis information | ||||
Control | 0..24 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Required for the adjudication by provided context for the services and product listed. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
454. Claim.diagnosis:other.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
456. Claim.diagnosis:other.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
458. Claim.diagnosis:other.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
460. Claim.diagnosis:other.sequence | |||||
Definition | A number to uniquely identify diagnosis entries. | ||||
Short | Diagnosis instance identifier | ||||
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
462. Claim.diagnosis:other.diagnosis[x] | |||||
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. | ||||
Short | Nature of illness or problem | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT ICD-10 Diagnostic Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes ) | ||||
Type | CodeableConcept | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Provides health context for the evaluation of the products and/or services. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
464. Claim.diagnosis:other.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Short | Timing or nature of the diagnosis | ||||
Comments | For example: admitting, primary, secondary, discharge. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleDiagnosisTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
466. Claim.diagnosis:other.onAdmission | |||||
Definition | Indication of whether the diagnosis was present on admission to a facility. | ||||
Short | Present on admission | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisOnAdmissionCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission )Present on admission. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Many systems need to understand for adjudication if the diagnosis was present a time of admission. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
468. Claim.diagnosis:other.packageCode | |||||
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. | ||||
Short | Package billing code | ||||
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisRelatedGroupCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup )The DRG codes associated with the diagnosis. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
470. Claim.procedure | |||||
Definition | Procedures performed on the patient relevant to the billing items with the claim. | ||||
Short | Clinical procedures performed | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on Claim.procedure . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
472. Claim.procedure.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
474. Claim.procedure.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 1..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.procedure.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
476. Claim.procedure.extension:serviceDescription | |||||
Slice Name | serviceDescription | ||||
Definition | This extension is used to communicate a plain language description of the procedure, product, or service. | ||||
Short | Service Description | ||||
Control | 1..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Service Description) (Extension Type: string) | ||||
Is Modifier | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
478. Claim.procedure.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
480. Claim.procedure.sequence | |||||
Definition | A number to uniquely identify procedure entries. | ||||
Short | Procedure instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
482. Claim.procedure.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Short | Category of Procedure | ||||
Comments | For example: primary, secondary. | ||||
Control | 0..* | ||||
Binding | The codes SHALL be taken from PCT Procedure Type Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
484. Claim.procedure.date | |||||
Definition | Date and optionally time the procedure was performed. | ||||
Short | When the procedure was performed | ||||
Control | 0..1 | ||||
Type | dateTime | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Required for auditing purposes. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
486. Claim.procedure.procedure[x] | |||||
Definition | The code or reference to a Procedure resource which identifies the clinical intervention performed. | ||||
Short | Specific clinical procedure | ||||
Control | 1..1 | ||||
Binding | For example codes, see ICD-10ProcedureCodes (example to http://hl7.org/fhir/ValueSet/icd-10-procedures )Example ICD10 Procedure codes. | ||||
Type | Choice of: CodeableConcept, Reference(Procedure) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | This identifies the actual clinical procedure. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
488. Claim.procedure.udi | |||||
Definition | Unique Device Identifiers associated with this line item. | ||||
Short | Unique device identifier | ||||
Control | 0..* | ||||
Type | Reference(Device) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
490. Claim.procedure:principal | |||||
Slice Name | principal | ||||
Definition | Procedures performed on the patient relevant to the billing items with the claim. | ||||
Short | Principal clinical procedure performed | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
492. Claim.procedure:principal.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
494. Claim.procedure:principal.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.procedure.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
496. Claim.procedure:principal.extension:serviceDescription | |||||
Slice Name | serviceDescription | ||||
Definition | This extension is used to communicate a plain language description of the procedure, product, or service. | ||||
Short | Service Description | ||||
Control | 1..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Service Description) (Extension Type: string) | ||||
Is Modifier | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
498. Claim.procedure:principal.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
500. Claim.procedure:principal.sequence | |||||
Definition | A number to uniquely identify procedure entries. | ||||
Short | Procedure instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to provide a mechanism to link to claim details. | ||||
Pattern Value | 1 | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
502. Claim.procedure:principal.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Short | Category of Procedure | ||||
Comments | For example: primary, secondary. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleProcedureTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-procedure-type )Example procedure type codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
504. Claim.procedure:principal.date | |||||
Definition | Date and optionally time the procedure was performed. | ||||
Short | When the procedure was performed | ||||
Control | 0..1 | ||||
Type | dateTime | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Required for auditing purposes. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
506. Claim.procedure:principal.procedure[x] | |||||
Definition | The code or reference to a Procedure resource which identifies the clinical intervention performed. | ||||
Short | Specific clinical procedure | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from ICD-10 Procedure Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes ) | ||||
Type | CodeableConcept | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | This identifies the actual clinical procedure. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
508. Claim.procedure:principal.udi | |||||
Definition | Unique Device Identifiers associated with this line item. | ||||
Short | Unique device identifier | ||||
Control | 0..* | ||||
Type | Reference(Device) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
510. Claim.procedure:other | |||||
Slice Name | other | ||||
Definition | Procedures performed on the patient relevant to the billing items with the claim. | ||||
Short | Clinical procedures performed | ||||
Control | 0..24 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
512. Claim.procedure:other.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
514. Claim.procedure:other.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.procedure.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
516. Claim.procedure:other.extension:serviceDescription | |||||
Slice Name | serviceDescription | ||||
Definition | This extension is used to communicate a plain language description of the procedure, product, or service. | ||||
Short | Service Description | ||||
Control | 1..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Service Description) (Extension Type: string) | ||||
Is Modifier | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
518. Claim.procedure:other.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
520. Claim.procedure:other.sequence | |||||
Definition | A number to uniquely identify procedure entries. | ||||
Short | Procedure instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to provide a mechanism to link to claim details. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
522. Claim.procedure:other.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Short | Category of Procedure | ||||
Comments | For example: primary, secondary. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleProcedureTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-procedure-type )Example procedure type codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Pattern Value | { | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
524. Claim.procedure:other.date | |||||
Definition | Date and optionally time the procedure was performed. | ||||
Short | When the procedure was performed | ||||
Control | 0..1 | ||||
Type | dateTime | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Required for auditing purposes. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
526. Claim.procedure:other.procedure[x] | |||||
Definition | The code or reference to a Procedure resource which identifies the clinical intervention performed. | ||||
Short | Specific clinical procedure | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes ) | ||||
Type | CodeableConcept | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | This identifies the actual clinical procedure. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
528. Claim.procedure:other.udi | |||||
Definition | Unique Device Identifiers associated with this line item. | ||||
Short | Unique device identifier | ||||
Control | 0..* | ||||
Type | Reference(Device) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
530. Claim.insurance | |||||
Definition | Financial instruments for reimbursement for the health care products and services specified on the claim. | ||||
Short | Patient insurance information | ||||
Comments | All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | At least one insurer is required for a claim to be a claim. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
532. Claim.insurance.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
534. Claim.insurance.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
536. Claim.insurance.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
538. Claim.insurance.sequence | |||||
Definition | A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order. | ||||
Short | Insurance instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | To maintain order of the coverages. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
540. Claim.insurance.focal | |||||
Definition | A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. | ||||
Short | Coverage to be used for adjudication | ||||
Comments | A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. | ||||
Control | 1..1 | ||||
Type | boolean | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | To identify which coverage in the list is being used to adjudicate this claim. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
542. Claim.insurance.identifier | |||||
Definition | The business identifier to be used when the claim is sent for adjudication against this insurance policy. | ||||
Short | Pre-assigned Claim number | ||||
Comments | Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'. | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..1 | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
544. Claim.insurance.coverage | |||||
Definition | Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. | ||||
Short | Insurance information | ||||
Control | 1..1 | ||||
Type | Reference(PCT Coverage) | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Required to allow the adjudicator to locate the correct policy and history within their information system. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
546. Claim.insurance.coverage.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
548. Claim.insurance.coverage.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.insurance.coverage.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
550. Claim.insurance.coverage.extension:dataAbsentReason | |||||
Slice Name | dataAbsentReason | ||||
Definition | Provides a reason why the expected value or elements in the element that is extended are missing. | ||||
Short | Coverage may be not applicable if estimate is for self-pay or uninsured | ||||
Control | 0..1 | ||||
Type | Extension(Data Absent Reason) (Extension Type: code) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
552. Claim.insurance.coverage.reference | |||||
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
Short | Literal reference, Relative, internal or absolute URL | ||||
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
554. Claim.insurance.coverage.type | |||||
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). | ||||
Short | Type the reference refers to (e.g. "Patient") | ||||
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to http://hl7.org/fhir/ValueSet/resource-types )Aa resource (or, for logical models, the URI of the logical model). | ||||
Type | uri | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
556. Claim.insurance.coverage.identifier | |||||
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
Short | Logical reference, when literal reference is not known | ||||
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 0..1 | ||||
Type | Identifier | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
558. Claim.insurance.coverage.display | |||||
Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
Short | Text alternative for the resource | ||||
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
560. Claim.insurance.businessArrangement | |||||
Definition | A business agreement number established between the provider and the insurer for special business processing purposes. | ||||
Short | Additional provider contract number | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
562. Claim.insurance.preAuthRef | |||||
Definition | Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. | ||||
Short | Prior authorization reference number | ||||
Comments | This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
564. Claim.insurance.claimResponse | |||||
Definition | The result of the adjudication of the line items for the Coverage specified in this insurance. | ||||
Short | Adjudication results | ||||
Comments | Must not be specified when 'focal=true' for this insurance. | ||||
Control | 0..1 | ||||
Type | Reference(ClaimResponse) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
566. Claim.accident | |||||
Definition | Details of an accident which resulted in injuries which required the products and services listed in the claim. | ||||
Short | Details of the event | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
568. Claim.accident.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
570. Claim.accident.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
572. Claim.accident.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
574. Claim.accident.date | |||||
Definition | Date of an accident event related to the products and services contained in the claim. | ||||
Short | When the incident occurred | ||||
Comments | The date of the accident has to precede the dates of the products and services but within a reasonable timeframe. | ||||
Control | 1..1 | ||||
Type | date | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Required for audit purposes and adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
576. Claim.accident.type | |||||
Definition | The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. | ||||
Short | The nature of the accident | ||||
Control | 0..1 | ||||
Binding | Unless not suitable, these codes SHALL be taken from ActIncidentCode (extensible to http://terminology.hl7.org/ValueSet/v3-ActIncidentCode )Type of accident: work place, auto, etc. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Coverage may be dependant on the type of accident. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
578. Claim.accident.location[x] | |||||
Definition | The physical location of the accident event. | ||||
Short | Where the event occurred | ||||
Control | 0..1 | ||||
Type | Address | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required for audit purposes and determination of applicable insurance liability. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
580. Claim.accident.location[x].id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
582. Claim.accident.location[x].extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.accident.location[x].extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
584. Claim.accident.location[x].use | |||||
Definition | The purpose of this address. | ||||
Short | home | work | temp | old | billing - purpose of this address | ||||
Comments | Applications can assume that an address is current unless it explicitly says that it is temporary or old. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from AddressUse (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1 )The use of an address. | ||||
Type | code | ||||
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | Allows an appropriate address to be chosen from a list of many. | ||||
Example | <br/><b>General</b>:home | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
586. Claim.accident.location[x].type | |||||
Definition | Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both. | ||||
Short | postal | physical | both | ||||
Comments | The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource). | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from AddressType (required to http://hl7.org/fhir/ValueSet/address-type|4.0.1 )The type of an address (physical / postal). | ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Example | <br/><b>General</b>:both | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
588. Claim.accident.location[x].text | |||||
Definition | Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts. | ||||
Short | Text representation of the address | ||||
Comments | Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Requirements | A renderable, unencoded form. | ||||
Example | <br/><b>General</b>:137 Nowhere Street, Erewhon 9132 | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
590. Claim.accident.location[x].line | |||||
Definition | This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information. | ||||
Short | Street name, number, direction & P.O. Box etc. | ||||
Control | 0..* | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Example | <br/><b>General</b>:137 Nowhere Street | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
592. Claim.accident.location[x].city | |||||
Definition | The name of the city, town, suburb, village or other community or delivery center. | ||||
Short | Name of city, town etc. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Alternate Names | Municpality | ||||
Example | <br/><b>General</b>:Erewhon | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
594. Claim.accident.location[x].district | |||||
Definition | The name of the administrative area (county). | ||||
Short | District name (aka county) | ||||
Comments | District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead. | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Alternate Names | County | ||||
Example | <br/><b>General</b>:Madison | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
596. Claim.accident.location[x].state | |||||
Definition | Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes). | ||||
Short | Sub-unit of country (abbreviations ok) | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Alternate Names | Province, Territory | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
598. Claim.accident.location[x].postalCode | |||||
Definition | A postal code designating a region defined by the postal service. | ||||
Short | Postal code for area | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Alternate Names | Zip | ||||
Example | <br/><b>General</b>:9132 | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
600. Claim.accident.location[x].country | |||||
Definition | Country - a nation as commonly understood or generally accepted. | ||||
Short | Country (e.g. can be ISO 3166 2 or 3 letter code) | ||||
Comments | ISO 3166 3 letter codes can be used in place of a human readable country name. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from Iso3166-1-2 (required to http://hl7.org/fhir/ValueSet/iso3166-1-2 ) | ||||
Type | string | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
602. Claim.accident.location[x].period | |||||
Definition | Time period when address was/is in use. | ||||
Short | Time period when address was/is in use | ||||
Control | 0..1 | ||||
Type | Period | ||||
Is Modifier | false | ||||
Summary | true | ||||
Requirements | Allows addresses to be placed in historical context. | ||||
Example | <br/><b>General</b>:{ "start" : "2010-03-23", "end" : "2010-07-01" } | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
604. Claim.item | |||||
Definition | A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details. | ||||
Short | Product or service provided | ||||
Control | 1..999 | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The items to be processed for adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
606. Claim.item.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
608. Claim.item.extension | |||||
Definition | An Extension | ||||
Short | Extension | ||||
Control | 1..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.item.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
610. Claim.item.extension:gfeBillingProviderLineItemCtrlNum | |||||
Slice Name | gfeBillingProviderLineItemCtrlNum | ||||
Definition | This extension is used by the provider to assign a unique identifier to this item. The intent of this element is to allow the provider to assign something other than 'line number' for their purposes (e.g. tracking and troubleshooting). | ||||
Short | Extension | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(GFEBillingProviderLineItemCtrlNum) (Extension Type: Identifier) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
612. Claim.item.extension:serviceDescription | |||||
Slice Name | serviceDescription | ||||
Definition | This extension is used to communicate a plain language description of the procedure, product, or service. | ||||
Short | Service Description | ||||
Control | 1..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(Service Description) (Extension Type: string) | ||||
Is Modifier | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
614. Claim.item.extension:ProviderEventMethodology | |||||
Slice Name | ProviderEventMethodology | ||||
Definition | This extension is used for indicating the method a provider used to group services, and those providing such services, beyond what may be indicated through DRGs that the payer or patient may find helpful (e.g. grouping services by a standardized episode of care definition). This is provider generated text and should not be modified by the payer. | ||||
Short | Provider Event Methodology | ||||
Comments | The method a provider used to group services. The extension definition contains additional detail | ||||
Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
Type | Extension(ProviderEventMethodology) (Extension Type: string) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
616. Claim.item.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
618. Claim.item.sequence | |||||
Definition | A number to uniquely identify item entries. | ||||
Short | Item instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
620. Claim.item.careTeamSequence | |||||
Definition | CareTeam members related to this service or product. | ||||
Short | Applicable careTeam members | ||||
Control | 0..* | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Need to identify the individuals and their roles in the provision of the product or service. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
622. Claim.item.diagnosisSequence | |||||
Definition | Diagnosis applicable for this service or product. | ||||
Short | Applicable diagnoses | ||||
Control | 0..* | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Need to related the product or service to the associated diagnoses. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
624. Claim.item.procedureSequence | |||||
Definition | Procedures applicable for this service or product. | ||||
Short | Applicable procedures | ||||
Control | 0..* | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Need to provide any listed specific procedures to support the product or service being claimed. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
626. Claim.item.informationSequence | |||||
Definition | Exceptions, special conditions and supporting information applicable for this service or product. | ||||
Short | Applicable exception and supporting information | ||||
Control | 0..* | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Need to reference the supporting information items that relate directly to this product or service. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
628. Claim.item.revenue | |||||
Definition | The type of revenue or cost center providing the product and/or service. | ||||
Short | Revenue or cost center code - must provide a value for the Institutional case | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT GFE NUBC Revenue Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemRevenueVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed in the processing of institutional claims. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
630. Claim.item.category | |||||
Definition | Code to identify the general type of benefits under which products and services are provided. | ||||
Short | Benefit classification | ||||
Comments | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. | ||||
Control | 0..1 | ||||
Binding | For example codes, see BenefitCategoryCodes (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory )Benefit categories such as: oral-basic, major, glasses. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
632. Claim.item.productOrService | |||||
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. | ||||
Short | Billing, service, product, or drug code | ||||
Comments | Can include null or N/A or data absent reason for the In-Patient Institutional case. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from Claim Medical Product or Service Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Necessary to state what was provided or done. | ||||
Alternate Names | Drug Code, Bill Code, Service Code | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
634. Claim.item.modifier | |||||
Definition | Item typification or modifiers codes to convey additional context for the product or service. | ||||
Short | Product or service billing modifiers | ||||
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. | ||||
Control | 0..4 | ||||
Binding | The codes SHALL be taken from PCT GFE Item CPT - HCPCS Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
636. Claim.item.programCode | |||||
Definition | Identifies the program under which this may be recovered. | ||||
Short | Program the product or service is provided under | ||||
Comments | For example: Neonatal program, child dental program or drug users recovery program. | ||||
Control | 0..* | ||||
Binding | For example codes, see ExampleProgramReasonCodes (example to http://hl7.org/fhir/ValueSet/ex-program-code )Program specific reason codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
638. Claim.item.serviced[x] | |||||
Definition | This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication | ||||
Short | This is the planned or estimated date(s)s of service | ||||
Control | 1..1 | ||||
Type | Choice of: date, Period | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Must Support | true | ||||
Must Support Types | No must-support rules about the choice of types/profiles | ||||
Summary | false | ||||
Requirements | Needed to determine whether the service or product was provided during the term of the insurance coverage. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
640. Claim.item.location[x] | |||||
Definition | Where the product or service was provided. | ||||
Short | Place of service or where product was supplied | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleServicePlaceCodes (example to http://hl7.org/fhir/ValueSet/service-place )Place of service: pharmacy, school, prison, etc. | ||||
Type | Choice of: CodeableConcept, Address, Reference(Location) | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
Slicing | This element introduces a set of slices on Claim.item.location[x] . The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
642. Claim.item.location[x]:locationCodeableConcept | |||||
Slice Name | locationCodeableConcept | ||||
Definition | Where the product or service was provided. | ||||
Short | Place of service or where product was supplied | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from PCT GFE CMS Place of Service Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOS ) | ||||
Type | CodeableConcept | ||||
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
644. Claim.item.quantity | |||||
Definition | The number of repetitions of a service or product. | ||||
Short | Count of products or services | ||||
Control | 1..1 | ||||
Type | Quantity(SimpleQuantity) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required when the product or service code does not convey the quantity provided. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
646. Claim.item.unitPrice | |||||
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. | ||||
Short | Fee, charge or cost per item | ||||
Control | 0..1 | ||||
Type | Money | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The amount charged to the patient by the provider for a single unit. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
648. Claim.item.factor | |||||
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. | ||||
Short | Price scaling factor | ||||
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). | ||||
Control | 0..1 | ||||
Type | decimal | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
650. Claim.item.net | |||||
Definition | The quantity times the unit price for an additional service or product or charge. | ||||
Short | Total charge amount for the service line | ||||
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. | ||||
Control | 1..1 | ||||
Type | Money | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
652. Claim.item.udi | |||||
Definition | Unique Device Identifiers associated with this line item. | ||||
Short | Unique device identifier | ||||
Control | 0..* | ||||
Type | Reference(Device) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
654. Claim.item.bodySite | |||||
Definition | Physical service site on the patient (limb, tooth, etc.). | ||||
Short | Anatomical location | ||||
Comments | For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed. | ||||
Control | 0..1 | ||||
Binding | For example codes, see OralSiteCodes (example to http://hl7.org/fhir/ValueSet/tooth )The code for the teeth, quadrant, sextant and arch. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Allows insurer to validate specific procedures. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
656. Claim.item.subSite | |||||
Definition | A region or surface of the bodySite, e.g. limb region or tooth surface(s). | ||||
Short | Anatomical sub-location | ||||
Control | 0..* | ||||
Binding | For example codes, see SurfaceCodes (example to http://hl7.org/fhir/ValueSet/surface )The code for the tooth surface and surface combinations. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Allows insurer to validate specific procedures. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
658. Claim.item.encounter | |||||
Definition | The Encounters during which this Claim was created or to which the creation of this record is tightly associated. | ||||
Short | Encounters related to this billed item | ||||
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. | ||||
Control | 0..* | ||||
Type | Reference(Encounter) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Used in some jurisdictions to link clinical events to claim items. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
660. Claim.item.detail | |||||
Definition | A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. | ||||
Short | Drug Identification Information | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | The items to be processed for adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
662. Claim.item.detail.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
664. Claim.item.detail.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
666. Claim.item.detail.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
668. Claim.item.detail.sequence | |||||
Definition | A number to uniquely identify item entries. | ||||
Short | Item instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
670. Claim.item.detail.revenue | |||||
Definition | The type of revenue or cost center providing the product and/or service. | ||||
Short | Revenue or cost center code | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleRevenueCenterCodes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center )Codes for the revenue or cost centers supplying the service and/or products. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed in the processing of institutional claims. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
672. Claim.item.detail.category | |||||
Definition | Code to identify the general type of benefits under which products and services are provided. | ||||
Short | Benefit classification | ||||
Comments | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. | ||||
Control | 0..1 | ||||
Binding | For example codes, see BenefitCategoryCodes (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory )Benefit categories such as: oral-basic, major, glasses. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
674. Claim.item.detail.productOrService | |||||
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. | ||||
Short | Billing, service, product, or drug code | ||||
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from PCT GFE Item NDC Value Set (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemNDCVS ) | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Necessary to state what was provided or done. | ||||
Alternate Names | Drug Code, Bill Code, Service Code | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
676. Claim.item.detail.modifier | |||||
Definition | Item typification or modifiers codes to convey additional context for the product or service. | ||||
Short | Service/Product billing modifiers | ||||
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. | ||||
Control | 0..* | ||||
Binding | For example codes, see ModifierTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-modifiers )Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
678. Claim.item.detail.programCode | |||||
Definition | Identifies the program under which this may be recovered. | ||||
Short | Program the product or service is provided under | ||||
Comments | For example: Neonatal program, child dental program or drug users recovery program. | ||||
Control | 0..* | ||||
Binding | For example codes, see ExampleProgramReasonCodes (example to http://hl7.org/fhir/ValueSet/ex-program-code )Program specific reason codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
680. Claim.item.detail.quantity | |||||
Definition | The number of repetitions of a service or product. | ||||
Short | Count of products or services | ||||
Control | 0..1 | ||||
Type | Quantity(SimpleQuantity) | ||||
Is Modifier | false | ||||
Must Support | true | ||||
Summary | false | ||||
Requirements | Required when the product or service code does not convey the quantity provided. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
682. Claim.item.detail.unitPrice | |||||
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. | ||||
Short | Fee, charge or cost per item | ||||
Control | 0..1 | ||||
Type | Money | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The amount charged to the patient by the provider for a single unit. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
684. Claim.item.detail.factor | |||||
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. | ||||
Short | Price scaling factor | ||||
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). | ||||
Control | 0..1 | ||||
Type | decimal | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
686. Claim.item.detail.net | |||||
Definition | The quantity times the unit price for an additional service or product or charge. | ||||
Short | Total item cost | ||||
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. | ||||
Control | 0..1 | ||||
Type | Money | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
688. Claim.item.detail.udi | |||||
Definition | Unique Device Identifiers associated with this line item. | ||||
Short | Unique device identifier | ||||
Control | 0..* | ||||
Type | Reference(Device) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
690. Claim.item.detail.subDetail | |||||
Definition | A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. | ||||
Short | Product or service provided | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The items to be processed for adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
692. Claim.item.detail.subDetail.id | |||||
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
Short | Unique id for inter-element referencing | ||||
Control | 0..1 | ||||
Type | string | ||||
Is Modifier | false | ||||
XML Format | In the XML format, this property is represented as an attribute. | ||||
Summary | false | ||||
694. Claim.item.detail.subDetail.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
696. Claim.item.detail.subDetail.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | ||||
Short | Extensions that cannot be ignored even if unrecognized | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them | ||||
Summary | true | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content, modifiers | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
698. Claim.item.detail.subDetail.sequence | |||||
Definition | A number to uniquely identify item entries. | ||||
Short | Item instance identifier | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
700. Claim.item.detail.subDetail.revenue | |||||
Definition | The type of revenue or cost center providing the product and/or service. | ||||
Short | Revenue or cost center code | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleRevenueCenterCodes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center )Codes for the revenue or cost centers supplying the service and/or products. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed in the processing of institutional claims. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
702. Claim.item.detail.subDetail.category | |||||
Definition | Code to identify the general type of benefits under which products and services are provided. | ||||
Short | Benefit classification | ||||
Comments | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. | ||||
Control | 0..1 | ||||
Binding | For example codes, see BenefitCategoryCodes (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory )Benefit categories such as: oral-basic, major, glasses. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
704. Claim.item.detail.subDetail.productOrService | |||||
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. | ||||
Short | Billing, service, product, or drug code | ||||
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. | ||||
Control | 1..1 | ||||
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls )Allowable service and product codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Necessary to state what was provided or done. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
706. Claim.item.detail.subDetail.modifier | |||||
Definition | Item typification or modifiers codes to convey additional context for the product or service. | ||||
Short | Service/Product billing modifiers | ||||
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. | ||||
Control | 0..* | ||||
Binding | For example codes, see ModifierTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-modifiers )Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
708. Claim.item.detail.subDetail.programCode | |||||
Definition | Identifies the program under which this may be recovered. | ||||
Short | Program the product or service is provided under | ||||
Comments | For example: Neonatal program, child dental program or drug users recovery program. | ||||
Control | 0..* | ||||
Binding | For example codes, see ExampleProgramReasonCodes (example to http://hl7.org/fhir/ValueSet/ex-program-code )Program specific reason codes. | ||||
Type | CodeableConcept | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
710. Claim.item.detail.subDetail.quantity | |||||
Definition | The number of repetitions of a service or product. | ||||
Short | Count of products or services | ||||
Control | 0..1 | ||||
Type | Quantity(SimpleQuantity) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Required when the product or service code does not convey the quantity provided. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
712. Claim.item.detail.subDetail.unitPrice | |||||
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. | ||||
Short | Fee, charge or cost per item | ||||
Control | 0..1 | ||||
Type | Money | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The amount charged to the patient by the provider for a single unit. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
714. Claim.item.detail.subDetail.factor | |||||
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. | ||||
Short | Price scaling factor | ||||
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). | ||||
Control | 0..1 | ||||
Type | decimal | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
716. Claim.item.detail.subDetail.net | |||||
Definition | The quantity times the unit price for an additional service or product or charge. | ||||
Short | Total item cost | ||||
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. | ||||
Control | 0..1 | ||||
Type | Money | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
718. Claim.item.detail.subDetail.udi | |||||
Definition | Unique Device Identifiers associated with this line item. | ||||
Short | Unique device identifier | ||||
Control | 0..* | ||||
Type | Reference(Device) | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
720. Claim.total | |||||
Definition | The total value of the all the items in the claim. | ||||
Short | Total GFE Charges Submitted | ||||
Control | 1..1 | ||||
Type | Money | ||||
Is Modifier | false | ||||
Summary | false | ||||
Requirements | Used for control total purposes. | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |