QI-Core Implementation Guide
4.1.0 - release

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## Resource Profile: QICoreClaim

Defining URL: | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim
Version: | 4.1.0
Name: | QICoreClaim
Status: | Draft as of 8/22/18
Definition: | Profile of Claim for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
Publisher: | http://www.hl7.org/Special/committees/cqi/index.cfm
Source Resource: | XML / JSON / Turtle

The official URL for this profile is:

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

Usage

See the patterns page for implementation and usage patterns.

### Examples

Simple Vision Claim

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Text Summary
- Differential Table
- Snapshot Table
- Snapshot Table (Must Support)
- All

This structure is derived from Claim

Summary

Must-Support: 5 elements

Structures

This structure refers to these other structures:

- QICorePatient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICorePractitioner (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner)
- QICorePractitionerRole (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole)
- QICoreOrganization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICoreDeviceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-devicerequest)
- QICoreMedicationRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest)
- QICoreRelatedPerson (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)
- QICoreServiceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest)
- QICoreLocation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location)

This structure is derived from Claim

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
patient | S | 1..1 | Reference(QICorePatient) | The recipient of the products and services
billablePeriod | S | 0..1 | Period | Relevant time frame for the claim
created | S | 1..1 | dateTime | Resource creation date
provider | S | 1..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization) | Party responsible for the claim
prescription | S | 0..1 | Reference(QICoreDeviceRequest | QICoreMedicationRequest | VisionPrescription) | Prescription authorizing services and products
payee |  | 0..1 | BackboneElement | Recipient of benefits payable
party |  | 0..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization | QICorePatient | QICoreRelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(QICoreServiceRequest) | Treatment referral
facility |  | 0..1 | Reference(QICoreLocation) | Servicing facility
careTeam |  | 0..* | BackboneElement | Members of the care team
provider |  | 1..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization) | Practitioner or organization
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business Identifier for claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | S Σ | 1..1 | Reference(QICorePatient) | The recipient of the products and services
billablePeriod | S Σ | 0..1 | Period | Relevant time frame for the claim
created | S Σ | 1..1 | dateTime | Resource creation date
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim
insurer | Σ | 0..1 | Reference(Organization) | Target
provider | S Σ | 1..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization) | Party responsible for the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related |  | 0..* | BackboneElement | Prior or corollary claims
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
claim |  | 0..1 | Reference(Claim) | Reference to the related claim
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference |  | 0..1 | Identifier | File or case reference
prescription | S | 0..1 | Reference(QICoreDeviceRequest | QICoreMedicationRequest | VisionPrescription) | Prescription authorizing services and products
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller
payee |  | 0..1 | BackboneElement | Recipient of benefits payable
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization | QICorePatient | QICoreRelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(QICoreServiceRequest) | Treatment referral
facility |  | 0..1 | Reference(QICoreLocation) | Servicing facility
careTeam |  | 0..* | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo |  | 0..* | BackboneElement | Supporting information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis |  | 0..* | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 |  | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
type |  | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure |  | 0..* | BackboneElement | Clinical procedures performed
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type |  | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 |  | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
udi |  | 0..* | Reference(Device) | Unique device identifier
insurance | Σ | 1..* | BackboneElement | Patient insurance information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
identifier |  | 0..1 | Identifier | Pre-assigned Claim number
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information
businessArrangement |  | 0..1 | string | Additional provider contract number
preAuthRef |  | 0..* | string | Prior authorization reference number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
accident |  | 0..1 | BackboneElement | Details of the event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 1..1 | date | When the incident occurred
type |  | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
location[x] |  | 0..1 |  | Where the event occurred
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
item |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
careTeamSequence |  | 0..* | positiveInt | Applicable careTeam members
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses
procedureSequence |  | 0..* | positiveInt | Applicable procedures
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (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..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
location[x] |  | 0..1 |  | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (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..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
subDetail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (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..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
total |  | 0..1 | Money | Total claim cost
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
patient | Σ | 1..1 | Reference(QICorePatient) | The recipient of the products and services
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim
created | Σ | 1..1 | dateTime | Resource creation date
provider | Σ | 1..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization) | Party responsible for the claim
prescription |  | 0..1 | Reference(QICoreDeviceRequest | QICoreMedicationRequest | VisionPrescription) | Prescription authorizing services and products
Documentation for this format

This structure is derived from Claim

Summary

Must-Support: 5 elements

Structures

This structure refers to these other structures:

- QICorePatient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICorePractitioner (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner)
- QICorePractitionerRole (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole)
- QICoreOrganization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICoreDeviceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-devicerequest)
- QICoreMedicationRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest)
- QICoreRelatedPerson (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)
- QICoreServiceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest)
- QICoreLocation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location)

Differential View

This structure is derived from Claim

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
patient | S | 1..1 | Reference(QICorePatient) | The recipient of the products and services
billablePeriod | S | 0..1 | Period | Relevant time frame for the claim
created | S | 1..1 | dateTime | Resource creation date
provider | S | 1..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization) | Party responsible for the claim
prescription | S | 0..1 | Reference(QICoreDeviceRequest | QICoreMedicationRequest | VisionPrescription) | Prescription authorizing services and products
payee |  | 0..1 | BackboneElement | Recipient of benefits payable
party |  | 0..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization | QICorePatient | QICoreRelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(QICoreServiceRequest) | Treatment referral
facility |  | 0..1 | Reference(QICoreLocation) | Servicing facility
careTeam |  | 0..* | BackboneElement | Members of the care team
provider |  | 1..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization) | Practitioner or organization
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business Identifier for claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | S Σ | 1..1 | Reference(QICorePatient) | The recipient of the products and services
billablePeriod | S Σ | 0..1 | Period | Relevant time frame for the claim
created | S Σ | 1..1 | dateTime | Resource creation date
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim
insurer | Σ | 0..1 | Reference(Organization) | Target
provider | S Σ | 1..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization) | Party responsible for the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related |  | 0..* | BackboneElement | Prior or corollary claims
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
claim |  | 0..1 | Reference(Claim) | Reference to the related claim
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference |  | 0..1 | Identifier | File or case reference
prescription | S | 0..1 | Reference(QICoreDeviceRequest | QICoreMedicationRequest | VisionPrescription) | Prescription authorizing services and products
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller
payee |  | 0..1 | BackboneElement | Recipient of benefits payable
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization | QICorePatient | QICoreRelatedPerson) | Recipient reference
referral |  | 0..1 | Reference(QICoreServiceRequest) | Treatment referral
facility |  | 0..1 | Reference(QICoreLocation) | Servicing facility
careTeam |  | 0..* | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo |  | 0..* | BackboneElement | Supporting information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis |  | 0..* | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 |  | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
type |  | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure |  | 0..* | BackboneElement | Clinical procedures performed
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type |  | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 |  | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
udi |  | 0..* | Reference(Device) | Unique device identifier
insurance | Σ | 1..* | BackboneElement | Patient insurance information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
identifier |  | 0..1 | Identifier | Pre-assigned Claim number
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information
businessArrangement |  | 0..1 | string | Additional provider contract number
preAuthRef |  | 0..* | string | Prior authorization reference number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
accident |  | 0..1 | BackboneElement | Details of the event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 1..1 | date | When the incident occurred
type |  | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
location[x] |  | 0..1 |  | Where the event occurred
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
item |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
careTeamSequence |  | 0..* | positiveInt | Applicable careTeam members
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses
procedureSequence |  | 0..* | positiveInt | Applicable procedures
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (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..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
location[x] |  | 0..1 |  | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (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..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
subDetail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (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..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
total |  | 0..1 | Money | Total claim cost
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet
Claim.language | preferred | CommonLanguages Max Binding: AllLanguages
Claim.status | required | FinancialResourceStatusCodes
Claim.type | extensible | ClaimTypeCodes
Claim.subType | example | ExampleClaimSubTypeCodes
Claim.use | required | Use
Claim.priority | example | ProcessPriorityCodes
Claim.fundsReserve | example | Funds Reservation Codes
Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodes
Claim.payee.type | example | Claim Payee Type Codes
Claim.careTeam.role | example | ClaimCareTeamRoleCodes
Claim.careTeam.qualification | example | ExampleProviderQualificationCodes
Claim.supportingInfo.category | example | ClaimInformationCategoryCodes
Claim.supportingInfo.code | example | ExceptionCodes
Claim.supportingInfo.reason | example | MissingToothReasonCodes
Claim.diagnosis.diagnosis[x] | example | ICD-10Codes
Claim.diagnosis.type | example | ExampleDiagnosisTypeCodes
Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodes
Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodes
Claim.procedure.type | example | ExampleProcedureTypeCodes
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodes
Claim.accident.type | extensible | ActIncidentCode
Claim.item.revenue | example | ExampleRevenueCenterCodes
Claim.item.category | example | BenefitCategoryCodes
Claim.item.productOrService | example | USCLSCodes
Claim.item.modifier | example | ModifierTypeCodes
Claim.item.programCode | example | ExampleProgramReasonCodes
Claim.item.location[x] | example | ExampleServicePlaceCodes
Claim.item.bodySite | example | OralSiteCodes
Claim.item.subSite | example | SurfaceCodes
Claim.item.detail.revenue | example | ExampleRevenueCenterCodes
Claim.item.detail.category | example | BenefitCategoryCodes
Claim.item.detail.productOrService | example | USCLSCodes
Claim.item.detail.modifier | example | ModifierTypeCodes
Claim.item.detail.programCode | example | ExampleProgramReasonCodes
Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodes
Claim.item.detail.subDetail.category | example | BenefitCategoryCodes
Claim.item.detail.subDetail.productOrService | example | USCLSCodes
Claim.item.detail.subDetail.modifier | example | ModifierTypeCodes
Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodes

#### Constraints

Id | Grade | Path | Details | Requirements
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Claim | 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 | error | Claim | 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 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | Best Practice | Claim | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | Claim.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.status | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.subType | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.patient | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.billablePeriod | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.created | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.enterer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.insurer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.priority | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.fundsReserve | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.related | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.related.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.related.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.related.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.related.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.related.claim | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.related.relationship | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.related.reference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.prescription | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.originalPrescription | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.payee | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.payee.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.payee.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.payee.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.payee.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.payee.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.payee.party | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.referral | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.facility | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.careTeam | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.careTeam.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.careTeam.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.careTeam.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.careTeam.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.careTeam.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.careTeam.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.careTeam.responsible | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.careTeam.role | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.careTeam.qualification | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.supportingInfo.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.supportingInfo.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.supportingInfo.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.supportingInfo.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.supportingInfo.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.supportingInfo.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.supportingInfo.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.supportingInfo.timing[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.supportingInfo.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.supportingInfo.reason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.diagnosis | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.diagnosis.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.diagnosis.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.diagnosis.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.diagnosis.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.diagnosis.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.diagnosis.diagnosis[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.diagnosis.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.diagnosis.onAdmission | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.diagnosis.packageCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.procedure | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.procedure.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.procedure.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.procedure.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.procedure.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.procedure.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.procedure.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.procedure.date | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.procedure.procedure[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.procedure.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.insurance | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.insurance.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.insurance.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.insurance.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.insurance.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.insurance.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.insurance.focal | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.insurance.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.insurance.coverage | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.insurance.businessArrangement | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.insurance.preAuthRef | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.insurance.claimResponse | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.accident | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.accident.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.accident.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.accident.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.accident.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.accident.date | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.accident.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.accident.location[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.item.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.item.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.item.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.item.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.careTeamSequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.diagnosisSequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.procedureSequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.informationSequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.revenue | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.programCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.serviced[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.location[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.unitPrice | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.factor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.net | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.bodySite | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.subSite | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.encounter | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.item.detail.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.item.detail.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.item.detail.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.item.detail.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.revenue | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.programCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.unitPrice | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.factor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.net | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.item.detail.subDetail.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.item.detail.subDetail.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Claim.item.detail.subDetail.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Claim.item.detail.subDetail.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.revenue | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.programCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.unitPrice | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.factor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.net | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.item.detail.subDetail.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Claim.total | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |