QI-Core Implementation Guide
4.1.0 - release

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## : Claim example - XML Representation

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    <Claim xmlns="http://hl7.org/fhir">
      <id value="example"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"/>
      </meta>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource "example" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-qicore-claim.html">QICoreClaim</a></p></div><p><b>identifier</b>: id: 6612346</p><p><b>status</b>: active</p><p><b>type</b>: Vision <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-claim-type.html">Claim Type Codes</a>#vision)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href="Patient-example.html">Patient/example</a> " CHALMERS"</p><p><b>created</b>: 2014-08-16</p><p><b>insurer</b>: <a href="Organization-example.html">Organization/example</a> "Health Level Seven International"</p><p><b>provider</b>: <a href="Practitioner-example.html">Practitioner/example</a> " CAREFUL"</p><p><b>priority</b>: Normal <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-processpriority.html">Process Priority Codes</a>#normal)</span></p><p><b>prescription</b>: <a href="MedicationRequest-example.html">MedicationRequest/example</a></p><h3>Payees</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td>*</td><td>Provider <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-payeetype.html">ClaimPayeeTypeCodes</a>#provider)</span></td><td><a href="Practitioner-example.html">Practitioner/example</a> " CAREFUL"</td></tr></table><h3>CareTeams</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td>*</td><td>1</td><td><a href="Practitioner-example.html">Practitioner/example</a> " CAREFUL"</td></tr></table><h3>Diagnoses</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td>*</td><td>1</td><td>654321 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (CodeSystem#654321)</span></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href="Coverage-example.html">Coverage/example</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: glasses <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (ex-visionservice#glasses)</span></p><p><b>serviced</b>: 2014-08-16</p><blockquote><p><b>detail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: frame <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (ex-visionservice#frame)</span></p></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: lens <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (ex-visionservice#lens)</span></p><p><b>quantity</b>: 2</p></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: fst <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (ex-visionservice#fst)</span></p><p><b>factor</b>: 0.07</p></blockquote></blockquote></div>
      </text>
      <identifier>
        <system value="http://happysight.com/claim"/>
        <value value="6612346"/>
      </identifier>
      <status value="active"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
          <code value="vision"/>
        </coding>
      </type>
      <use value="claim"/>
      <patient>
        <reference value="Patient/example"/>
      </patient>
      <created value="2014-08-16"/>
      <insurer>
        <reference value="Organization/example"/>
      </insurer>
      <provider>
        <reference value="Practitioner/example"/>
      </provider>
      <priority>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
          <code value="normal"/>
        </coding>
      </priority>
      <prescription>
        <reference value="MedicationRequest/example"/>
      </prescription>
      <payee>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/payeetype"/>
            <code value="provider"/>
          </coding>
        </type>
        <party>
          <reference value="Practitioner/example"/>
        </party>
      </payee>
      <careTeam>
        <sequence value="1"/>
        <provider>
          <reference value="Practitioner/example"/>
        </provider>
      </careTeam>
      <diagnosis>
        <sequence value="1"/>
        <diagnosisCodeableConcept>
          <coding>
            <system value="http://example.org/diagnosis/CodeSystem"/>
            <code value="654321"/>
          </coding>
        </diagnosisCodeableConcept>
      </diagnosis>
      <insurance>
        <sequence value="1"/>
        <focal value="true"/>
        <coverage>
          <reference value="Coverage/example"/>
        </coverage>
      </insurance>
      <item>
        <sequence value="1"/>
        <careTeamSequence value="1"/>
        <productOrService>
          <coding>
            <system value="http://example.org/fhir/CodeSystem/ex-visionservice"/>
            <code value="glasses"/>
          </coding>
        </productOrService>
        <servicedDate value="2014-08-16"/>
        <unitPrice>
          <value value="214.00"/>
          <currency value="USD"/>
        </unitPrice>
        <detail>
          <sequence value="1"/>
          <productOrService>
            <coding>
              <system value="http://example.org/fhir/CodeSystem/ex-visionservice"/>
              <code value="frame"/>
            </coding>
          </productOrService>
          <unitPrice>
            <value value="100.00"/>
            <currency value="USD"/>
          </unitPrice>
          <net>
            <value value="100.00"/>
            <currency value="USD"/>
          </net>
        </detail>
        <detail>
          <sequence value="2"/>
          <productOrService>
            <coding>
              <system value="http://example.org/fhir/CodeSystem/ex-visionservice"/>
              <code value="lens"/>
            </coding>
          </productOrService>
          <quantity>
            <value value="2"/>
          </quantity>
          <unitPrice>
            <value value="50.00"/>
            <currency value="USD"/>
          </unitPrice>
          <net>
            <value value="100.00"/>
            <currency value="USD"/>
          </net>
        </detail>
        <detail>
          <sequence value="3"/>
          <productOrService>
            <coding>
              <system value="http://example.org/fhir/CodeSystem/ex-visionservice"/>
              <code value="fst"/>
            </coding>
          </productOrService>
          <unitPrice>
            <value value="200.00"/>
            <currency value="USD"/>
          </unitPrice>
          <factor value="0.07"/>
          <net>
            <value value="14.00"/>
            <currency value="USD"/>
          </net>
        </detail>
      </item>
    </Claim>