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 & Constraintsdoco
.. Claim 0..*Claim, Pre-determination or Pre-authorization
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
... meta Σ0..1MetaMetadata about the resource
ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.


ele-1: All FHIR elements must have a @value or children
... text 0..1NarrativeText summary of the resource, for human interpretation
ele-1: All FHIR elements must have a @value or children
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... identifier 0..*IdentifierBusiness Identifier for claim
ele-1: All FHIR elements must have a @value or children
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: ?? (required): A code specifying the state of the resource instance.


ele-1: All FHIR elements must have a @value or children
... type Σ1..1CodeableConceptCategory or discipline
Binding: ?? (extensible): The type or discipline-style of the claim.


ele-1: All FHIR elements must have a @value or children
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.


ele-1: All FHIR elements must have a @value or children
... use Σ1..1codeclaim | preauthorization | predetermination
Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim.


ele-1: All FHIR elements must have a @value or children
... patient Σ1..1Reference(QICore Patient | #sd-qicore-patient-qicore-patient)left: (QI-Core) The recipient of the products and services; right: (QI) The recipient of the products and services
ele-1: All FHIR elements must have a @value or children
... billablePeriod Σ0..1Periodleft: (QI-Core) Relevant time frame for the claim; right: (QI) Relevant time frame for the claim
ele-1: All FHIR elements must have a @value or children
... created Σ1..1dateTimeleft: (QI-Core) Resource creation date; right: (QI) Resource creation date
ele-1: All FHIR elements must have a @value or children
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
ele-1: All FHIR elements must have a @value or children
... insurer Σ0..1Reference(Organization)Target
ele-1: All FHIR elements must have a @value or children
... provider Σ1..1Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization | #sd-qicore-practitioner-qicore-practitioner)left: (QI-Core) Party responsible for the claim; right: (QI) Party responsible for the claim
ele-1: All FHIR elements must have a @value or children
... priority Σ1..1CodeableConceptDesired processing ugency
Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.


ele-1: All FHIR elements must have a @value or children
... fundsReserve 0..1CodeableConceptFor whom to reserve funds
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).


ele-1: All FHIR elements must have a @value or children
... related 0..*BackboneElementPrior or corollary claims
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... claim 0..1Reference(Claim)Reference to the related claim
ele-1: All FHIR elements must have a @value or children
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ?? (example): Relationship of this claim to a related Claim.


ele-1: All FHIR elements must have a @value or children
.... reference 0..1IdentifierFile or case reference
ele-1: All FHIR elements must have a @value or children
... prescription 0..1Reference(QICore DeviceRequest | QICore MedicationRequest | VisionPrescription | #sd-qicore-devicerequest-qicore-devicerequest)left: (QI-Core) Prescription authorizing services and products; right: (QI) Prescription authorizing services and products
ele-1: All FHIR elements must have a @value or children
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
ele-1: All FHIR elements must have a @value or children
... payee 0..1BackboneElementRecipient of benefits payable
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type 1..1CodeableConceptCategory of recipient
Binding: ?? (example): A code for the party to be reimbursed.


ele-1: All FHIR elements must have a @value or children
.... party 0..1Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization | QICore Patient | QICore RelatedPerson | #sd-qicore-practitioner-qicore-practitioner)Recipient reference
ele-1: All FHIR elements must have a @value or children
... referral 0..1Reference(QICore ServiceRequest | #sd-qicore-servicerequest-qicore-servicerequest)Treatment referral
ele-1: All FHIR elements must have a @value or children
... facility 0..1Reference(QICore Location | #sd-qicore-location-qicore-location)Servicing facility
ele-1: All FHIR elements must have a @value or children
... careTeam 0..*BackboneElementMembers of the care team
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntOrder of care team
ele-1: All FHIR elements must have a @value or children
.... provider 1..1Reference(QICore Practitioner | QICore PractitionerRole | QICore Organization | #sd-qicore-practitioner-qicore-practitioner)Practitioner or organization
ele-1: All FHIR elements must have a @value or children
.... responsible 0..1booleanIndicator of the lead practitioner
ele-1: All FHIR elements must have a @value or children
.... role 0..1CodeableConceptFunction within the team
Binding: ?? (example): The role codes for the care team members.


ele-1: All FHIR elements must have a @value or children
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ?? (example): Provider professional qualifications.


ele-1: All FHIR elements must have a @value or children
... supportingInfo 0..*BackboneElementSupporting information
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntInformation instance identifier
ele-1: All FHIR elements must have a @value or children
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ?? (example): The valuset used for additional information category codes.


ele-1: All FHIR elements must have a @value or children
.... code 0..1CodeableConceptType of information
Binding: ?? (example): The valuset used for additional information codes.


ele-1: All FHIR elements must have a @value or children
.... timing[x] 0..1When it occurred
ele-1: All FHIR elements must have a @value or children
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
ele-1: All FHIR elements must have a @value or children
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason 0..1CodeableConceptExplanation for the information
Binding: ?? (example): Reason codes for the missing teeth.


ele-1: All FHIR elements must have a @value or children
... diagnosis 0..*BackboneElementleft: Pertinent diagnosis information; right: (QI) Pertinent diagnosis information
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntleft: (QI-Core) Diagnosis instance identifier; right: (QI) Diagnosis instance identifier
ele-1: All FHIR elements must have a @value or children
.... diagnosis[x] 1..1left: (QI-Core) Nature of illness or problem; right: (QI) Nature of illness or problem
Binding: ?? (example): Example ICD10 Diagnostic codes.


ele-1: All FHIR elements must have a @value or children
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(QICore Condition Encounter Diagnosis | #sd-qicore-condition-encounter-diagnosis-qicore-condition-encounter-diagnosis)
.... type 0..*CodeableConceptleft: Timing or nature of the diagnosis; right: (QI) Timing or nature of the diagnosis
Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge.


ele-1: All FHIR elements must have a @value or children
.... onAdmission 0..1CodeableConceptleft: (QI-Core) Present on admission; right: (QI) Present on admission
Binding: ?? (required): Present on admission.


ele-1: All FHIR elements must have a @value or children
.... packageCode 0..1CodeableConceptPackage billing code
Binding: ?? (example): The DRG codes associated with the diagnosis.


ele-1: All FHIR elements must have a @value or children
... procedure 0..*BackboneElementleft: Clinical procedures performed; right: (QI) Clinical procedures performed
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntleft: (QI-Core) Procedure instance identifier; right: (QI) Procedure instance identifier
ele-1: All FHIR elements must have a @value or children
.... type 0..*CodeableConceptleft: Category of Procedure; right: (QI) Category of Procedure
Binding: ?? (example): Example procedure type codes.


ele-1: All FHIR elements must have a @value or children
.... date 0..1dateTimeWhen the procedure was performed
ele-1: All FHIR elements must have a @value or children
.... procedure[x] 1..1left: (QI-Core) Specific clinical procedure; right: (QI) Specific clinical procedure
Binding: ?? (example): Example ICD10 Procedure codes.


ele-1: All FHIR elements must have a @value or children
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(QICore Procedure | #sd-qicore-procedure-qicore-procedure)
.... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
... insurance Σ1..*BackboneElementPatient insurance information
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence Σ1..1positiveIntInsurance instance identifier
ele-1: All FHIR elements must have a @value or children
.... focal Σ1..1booleanCoverage to be used for adjudication
ele-1: All FHIR elements must have a @value or children
.... identifier 0..1IdentifierPre-assigned Claim number
ele-1: All FHIR elements must have a @value or children
.... coverage Σ1..1Reference(Coverage)Insurance information
ele-1: All FHIR elements must have a @value or children
.... businessArrangement 0..1stringAdditional provider contract number
ele-1: All FHIR elements must have a @value or children
.... preAuthRef 0..*stringPrior authorization reference number
ele-1: All FHIR elements must have a @value or children
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
ele-1: All FHIR elements must have a @value or children
... accident 0..1BackboneElementDetails of the event
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... date 1..1dateWhen the incident occurred
ele-1: All FHIR elements must have a @value or children
.... type 0..1CodeableConceptThe nature of the accident
Binding: ?? (extensible): Type of accident: work place, auto, etc.


ele-1: All FHIR elements must have a @value or children
.... location[x] 0..1Where the event occurred
ele-1: All FHIR elements must have a @value or children
..... locationAddressAddress
..... locationReferenceReference(Location)
... item 0..*BackboneElementProduct or service provided
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntItem instance identifier
ele-1: All FHIR elements must have a @value or children
.... careTeamSequence 0..*positiveIntApplicable careTeam members
ele-1: All FHIR elements must have a @value or children
.... diagnosisSequence 0..*positiveIntApplicable diagnoses
ele-1: All FHIR elements must have a @value or children
.... procedureSequence 0..*positiveIntApplicable procedures
ele-1: All FHIR elements must have a @value or children
.... informationSequence 0..*positiveIntApplicable exception and supporting information
ele-1: All FHIR elements must have a @value or children
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.


ele-1: All FHIR elements must have a @value or children
.... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.


ele-1: All FHIR elements must have a @value or children
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
.... 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.


ele-1: All FHIR elements must have a @value or children
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
.... serviced[x] 0..1Date or dates of service or product delivery
ele-1: All FHIR elements must have a @value or children
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.


ele-1: All FHIR elements must have a @value or children
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1??Count of products or services
ele-1: All FHIR elements must have a @value or children
.... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
.... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
.... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
.... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.


ele-1: All FHIR elements must have a @value or children
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.


ele-1: All FHIR elements must have a @value or children
.... encounter 0..*Reference(QICore Encounter | #sd-qicore-encounter-qicore-encounter)left: (QI-Core) Encounters related to this billed item; right: (QI) Encounters related to this billed item
ele-1: All FHIR elements must have a @value or children
.... detail 0..*BackboneElementProduct or service provided
ele-1: All FHIR elements must have a @value or children
..... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... sequence 1..1positiveIntItem instance identifier
ele-1: All FHIR elements must have a @value or children
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.


ele-1: All FHIR elements must have a @value or children
..... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.


ele-1: All FHIR elements must have a @value or children
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
..... 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.


ele-1: All FHIR elements must have a @value or children
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
..... quantity 0..1??Count of products or services
ele-1: All FHIR elements must have a @value or children
..... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
..... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
..... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
..... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
..... subDetail 0..*BackboneElementProduct or service provided
ele-1: All FHIR elements must have a @value or children
...... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... sequence 1..1positiveIntItem instance identifier
ele-1: All FHIR elements must have a @value or children
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.


ele-1: All FHIR elements must have a @value or children
...... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.


ele-1: All FHIR elements must have a @value or children
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
...... 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.


ele-1: All FHIR elements must have a @value or children
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
...... quantity 0..1??Count of products or services
ele-1: All FHIR elements must have a @value or children
...... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
...... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
...... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
...... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
... total 0..1MoneyTotal claim cost
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format