Profile Comparison between http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim vs http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/Claim
copyright
date	2018-08-22
description	Profile of Claim for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
experimental	false
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	QICoreClaim
publisher	HL7 International / Clinical Quality Information
purpose
status	active
title	QICore Claim
type	Claim
url	http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim
version	6.0.0	7.0.0-ballot	Values Differ

Structure

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