Union of http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim and http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim

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

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..*Claim, Pre-determination or Pre-authorization
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.
... text 0..1NarrativeText summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier for claim
... status ?!Σ1..1code(QI) active
Binding: ?? (required): A code specifying the state of the resource instance.
... type Σ1..1CodeableConcept(QI) category | discipline
Binding: ?? (extensible): The type or discipline-style of the claim.
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
... use Σ1..1code(QI) claim | preauthorization | predetermination
Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient Σ1..1Reference(QICore Patient | #sd-qicore-patient-qicore-patient)(QI) The recipient of the products and services
... billablePeriod Σ0..1Period(QI) Relevant time frame for the claim
... created Σ1..1dateTime(QI) Resource creation date
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer Σ0..1Reference(Organization)Target
... provider Σ1..1Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization | #sd-qicore-practitioner-qicore-practitioner)(QI) Party responsible for the claim
... priority Σ1..1CodeableConceptDesired processing ugency
Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1CodeableConceptFor whom to reserve funds
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..*BackboneElementPrior or corollary claims
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ?? (example): Relationship of this claim to a related Claim.
.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(QICore DeviceRequest | QICore MedicationRequest | VisionPrescription), Reference(QICore DeviceRequest | QICore MedicationRequest | VisionPrescription)(QI) Prescription authorizing services and products
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptCategory of recipient
Binding: ?? (example): A code for the party to be reimbursed.
.... party 0..1Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization | QICore Patient | QICore RelatedPerson | #sd-qicore-practitioner-qicore-practitioner)Recipient reference
... referral 0..1Reference(QICore ServiceRequest | #sd-qicore-servicerequest-qicore-servicerequest)Treatment referral
... facility 0..1Reference(QICore Location | #sd-qicore-location-qicore-location)Servicing facility
... careTeam 0..*BackboneElementMembers of the care team
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntOrder of care team
.... provider 1..1Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization | #sd-qicore-practitioner-qicore-practitioner)Practitioner or organization
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Binding: ?? (example): The role codes for the care team members.
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ?? (example): Provider professional qualifications.
... supportingInfo 0..*BackboneElementSupporting information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ?? (example): The valuset used for additional information category codes.
.... code 0..1CodeableConceptType of information
Binding: ?? (example): The valuset used for additional information codes.
.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason 0..1CodeableConceptExplanation for the information
Binding: ?? (example): Reason codes for the missing teeth.
... diagnosis 0..*BackboneElement(QI) Pertinent diagnosis information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveInt(QI) Diagnosis instance identifier
.... diagnosis[x] 1..1(QI) Nature of illness or problem
Binding: ?? (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(QICore Condition Encounter Diagnosis | #sd-qicore-condition-encounter-diagnosis-qicore-condition-encounter-diagnosis)
.... type 0..*CodeableConcept(QI) Timing or nature of the diagnosis
Binding: ?? (preferred): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1CodeableConcept(QI) Present on admission
Binding: ?? (required): Present on admission.
.... packageCode 0..1CodeableConceptPackage billing code
Binding: ?? (example): The DRG codes associated with the diagnosis.
... procedure 0..*BackboneElement(QI) Clinical procedures performed
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveInt(QI) Procedure instance identifier
.... type 0..*CodeableConcept(QI) Category of Procedure
Binding: ?? (example): Example procedure type codes.
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1(QI) Specific clinical procedure
Binding: ?? (example): Example ICD10 Procedure codes.
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(QICore Procedure | #sd-qicore-procedure-qicore-procedure)
.... udi 0..*Reference(Device)Unique device identifier
... insurance Σ1..*BackboneElementPatient insurance information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ1..1positiveIntInsurance instance identifier
.... focal Σ1..1booleanCoverage to be used for adjudication
.... identifier 0..1IdentifierPre-assigned Claim number
.... coverage Σ1..1Reference(QICore Coverage | #sd-qicore-coverage-qicore-coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
.... preAuthRef 0..*stringPrior authorization reference number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... accident 0..1BackboneElementDetails of the event
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date 1..1dateWhen the incident occurred
.... type 0..1CodeableConceptThe nature of the accident
Binding: ?? (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item 0..*BackboneElementProduct or service provided
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntItem instance identifier
.... careTeamSequence 0..*positiveIntApplicable careTeam members
.... diagnosisSequence 0..*positiveIntApplicable diagnoses
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
.... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1??Count of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... udi 0..*Reference(Device)Unique device identifier
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.
.... encounter 0..*Reference(QICore Encounter | #sd-qicore-encounter-qicore-encounter)(QI) Encounters related to this billed item
.... detail 0..*BackboneElementProduct or service provided
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntItem instance identifier
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
..... quantity 0..1??Count of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... udi 0..*Reference(Device)Unique device identifier
..... subDetail 0..*BackboneElementProduct or service provided
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence 1..1positiveIntItem instance identifier
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
...... quantity 0..1??Count of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... udi 0..*Reference(Device)Unique device identifier
... total 0..1MoneyTotal claim cost

doco Documentation for this format