Kenya National Cancer Control Programme (NCCP) FHIR Implementation Guide
0.1.0 - ci-build
Kenya National Cancer Control Programme (NCCP) FHIR Implementation Guide
0.1.0 - ci-build
Kenya National Cancer Control Programme (NCCP) FHIR Implementation Guide, published by Digital Health Agency (DHA), Kenya. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/nccpFHIRIG/ and changes regularly. See the Directory of published versions
| Official URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-oncology-claim | Version: 0.1.0 | ||||
| Draft as of 2026-06-04 | Computable Name: OncologyClaim | ||||
Insurance claim for oncology treatment submitted to SHA, including staging, treatment setting and session details.
Usages:
You can also check for usages in the FHIR IG Statistics
Description Differentials, Snapshots, and other representations.
| Path | Status | Usage | ValueSet | Version | Source |
| Claim.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| Claim.type | Base | required | Claim Type Codes | 📦4.0.1 | FHIR Std. |
| Claim.subType | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.use | Base | required | Use | 📦4.0.1 | FHIR Std. |
| Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std. |
| Claim.supportingInfo.category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.item.detail.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Id | Grade | Path(s) | Description | Expression |
| 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 | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
| Path | Status | Usage | ValueSet | Version | Source |
| Claim.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| Claim.type | Base | required | Claim Type Codes | 📦4.0.1 | FHIR Std. |
| Claim.subType | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.use | Base | required | Use | 📦4.0.1 | FHIR Std. |
| Claim.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.item.detail.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Name | Flags | Card. | Type | Description & Constraints Filter:   | ||||
|---|---|---|---|---|---|---|---|---|
  Claim |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||
  id |
Σ | 0..1 | id | Logical id of this artifact | ||||
  meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
 id |
0..1 | string | Unique id for inter-element referencing | |||||
 extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated |
Σ | 0..1 | instant | When the resource version last changed | ||||
| source |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile |
SΣ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
 tag |
Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| 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): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
6..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
  extension:carcinomaStaging |
S | 1..1 | code | Carcinoma Staging Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-carcinoma-staging-extension Binding: Kenya Cancer Stage Summary Value Set (required) | ||||
| extension:metastasesSites |
S | 0..* | code | Metastases Sites Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-metastases-sites-extension Binding: Kenya Metastases Sites Value Set (required) | ||||
| extension:treatmentSetting |
S | 1..* | code | Treatment Setting Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-treatment-setting-extension Binding: Kenya Treatment Setting Value Set (required) | ||||
| extension:sessionExpectedDate |
S | 1..1 | date | Session Expected Date Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-session-expected-date-extension | ||||
| extension:sessionsRequired |
S | 1..1 | integer | Sessions Required Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-sessions-required-extension | ||||
| extension:costPerSession |
S | 1..1 | Money | Cost Per Session Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-cost-per-session-extension | ||||
| extension:cycleNumber |
S | 0..1 | integer | Cycle Number Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-cycle-number-extension | ||||
| extension:sessionNumber |
S | 0..1 | integer | Session Number Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-session-number-extension | ||||
| extension:regimenReference |
S | 1..1 | Reference(CarePlan) | Regimen Reference Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-regimen-reference-extension | ||||
| extension:parentAuthorization |
S | 0..1 | Reference(Claim) | Parent Authorization Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-parent-authorization-extension | ||||
| extension:hasCoinsurance |
S | 0..1 | boolean | Has Coinsurance Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-has-coinsurance-extension | ||||
| extension:coinsuranceDetails |
S | 0..1 | string | Coinsurance Details Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-coinsurance-details-extension | ||||
 extension:comorbidity |
S | 0..1 | string | Comorbidity Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-comorbidity-extension | ||||
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Business Identifier for claim | |||||
| status |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) | ||||
| type |
SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (required) | ||||
| subType |
S | 0..1 | CodeableConcept | More granular claim type Binding: Kenya SHA Oncology Interventions Value Set (required) | ||||
| use |
SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required) | ||||
 patient |
SΣ | 1..1 | Reference(Patient) | The recipient of the products and services | ||||
| billablePeriod |
Σ | 0..1 | Period | Relevant time frame for the claim | ||||
| created |
SΣ | 1..1 | dateTime | Resource creation date | ||||
| enterer |
0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||
| insurer |
Σ | 0..1 | Reference(Organization) | Target | ||||
| provider |
SΣ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | 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 |
0..1 | Reference(DeviceRequest | MedicationRequest | 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(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
| referral |
0..1 | Reference(ServiceRequest) | Treatment referral | |||||
| facility |
0..1 | Reference(Location) | 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(Practitioner | PractitionerRole | Organization) | 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] |
S | 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 | |||||
 Slices for diagnosis[x] |
1..1 | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||||||
| diagnosisCodeableConcept |
CodeableConcept | |||||||
| diagnosisReference |
Reference(Condition) | |||||||
| diagnosis[x]:diagnosisReference |
S | 0..1 | Reference(NCCP Oncology Diagnosis Condition) | Nature of illness or problem | ||||
| 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 |
SΣ | 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: V3 Value SetActIncidentCode (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 |
S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Kenya SHA Oncology Interventions Value Set (required) | ||||
| 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 |
S | 1..1 | SimpleQuantity(4.0.1) | Count of products or services | ||||
| unitPrice |
S | 1..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 |
S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Kenya SHA Oncology Interventions Value Set (required) | ||||
| 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 |
S | 0..1 | SimpleQuantity(4.0.1) | Count of products or services | ||||
| unitPrice |
S | 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(4.0.1) | 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 | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Claim.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| Claim.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| Claim.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| Claim.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| Claim.type | Base | required | Claim Type Codes | 📦4.0.1 | FHIR Std. |
| Claim.subType | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.use | Base | required | Use | 📦4.0.1 | FHIR Std. |
| Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std. |
| Claim.fundsReserve | Base | example | FundsReserve | 📍4.0.1 | FHIR Std. |
| Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std. |
| Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std. |
| Claim.careTeam.role | Base | example | Claim Care Team Role Codes | 📍4.0.1 | FHIR Std. |
| Claim.careTeam.qualification | Base | example | Example Provider Qualification Codes | 📍4.0.1 | FHIR Std. |
| Claim.supportingInfo.category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.supportingInfo.code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std. |
| Claim.supportingInfo.reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std. |
| Claim.procedure.type | Base | example | Example Procedure Type Codes | 📍4.0.1 | FHIR Std. |
| Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std. |
| Claim.accident.type | Base | extensible | V3 Value SetActIncidentCode | 📦2014-03-26 | FHIR Std. |
| Claim.item.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.item.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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 | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Summary
Mandatory: 6 elements(3 nested mandatory elements)
Must-Support: 30 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Key Elements View
| Path | Status | Usage | ValueSet | Version | Source |
| Claim.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| Claim.type | Base | required | Claim Type Codes | 📦4.0.1 | FHIR Std. |
| Claim.subType | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.use | Base | required | Use | 📦4.0.1 | FHIR Std. |
| Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std. |
| Claim.supportingInfo.category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.item.detail.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Id | Grade | Path(s) | Description | Expression |
| 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 | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
| Path | Status | Usage | ValueSet | Version | Source |
| Claim.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| Claim.type | Base | required | Claim Type Codes | 📦4.0.1 | FHIR Std. |
| Claim.subType | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.use | Base | required | Use | 📦4.0.1 | FHIR Std. |
| Claim.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.item.detail.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
Snapshot ViewView
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| Claim |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated |
Σ | 0..1 | instant | When the resource version last changed | ||||
| source |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile |
SΣ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag |
Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| 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): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
6..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:carcinomaStaging |
S | 1..1 | code | Carcinoma Staging Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-carcinoma-staging-extension Binding: Kenya Cancer Stage Summary Value Set (required) | ||||
| extension:metastasesSites |
S | 0..* | code | Metastases Sites Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-metastases-sites-extension Binding: Kenya Metastases Sites Value Set (required) | ||||
| extension:treatmentSetting |
S | 1..* | code | Treatment Setting Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-treatment-setting-extension Binding: Kenya Treatment Setting Value Set (required) | ||||
| extension:sessionExpectedDate |
S | 1..1 | date | Session Expected Date Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-session-expected-date-extension | ||||
| extension:sessionsRequired |
S | 1..1 | integer | Sessions Required Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-sessions-required-extension | ||||
| extension:costPerSession |
S | 1..1 | Money | Cost Per Session Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-cost-per-session-extension | ||||
| extension:cycleNumber |
S | 0..1 | integer | Cycle Number Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-cycle-number-extension | ||||
| extension:sessionNumber |
S | 0..1 | integer | Session Number Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-session-number-extension | ||||
| extension:regimenReference |
S | 1..1 | Reference(CarePlan) | Regimen Reference Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-regimen-reference-extension | ||||
| extension:parentAuthorization |
S | 0..1 | Reference(Claim) | Parent Authorization Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-parent-authorization-extension | ||||
| extension:hasCoinsurance |
S | 0..1 | boolean | Has Coinsurance Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-has-coinsurance-extension | ||||
| extension:coinsuranceDetails |
S | 0..1 | string | Coinsurance Details Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-coinsurance-details-extension | ||||
| extension:comorbidity |
S | 0..1 | string | Comorbidity Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-comorbidity-extension | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Business Identifier for claim | |||||
| status |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required) | ||||
| type |
SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (required) | ||||
| subType |
S | 0..1 | CodeableConcept | More granular claim type Binding: Kenya SHA Oncology Interventions Value Set (required) | ||||
| use |
SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required) | ||||
| patient |
SΣ | 1..1 | Reference(Patient) | The recipient of the products and services | ||||
| billablePeriod |
Σ | 0..1 | Period | Relevant time frame for the claim | ||||
| created |
SΣ | 1..1 | dateTime | Resource creation date | ||||
| enterer |
0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||
| insurer |
Σ | 0..1 | Reference(Organization) | Target | ||||
| provider |
SΣ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | 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 |
0..1 | Reference(DeviceRequest | MedicationRequest | 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(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
| referral |
0..1 | Reference(ServiceRequest) | Treatment referral | |||||
| facility |
0..1 | Reference(Location) | 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(Practitioner | PractitionerRole | Organization) | 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] |
S | 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 | |||||
| Slices for diagnosis[x] |
1..1 | Nature of illness or problem Slice: Unordered, Open by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||||||
| diagnosisCodeableConcept |
CodeableConcept | |||||||
| diagnosisReference |
Reference(Condition) | |||||||
| diagnosis[x]:diagnosisReference |
S | 0..1 | Reference(NCCP Oncology Diagnosis Condition) | Nature of illness or problem | ||||
| 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 |
SΣ | 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: V3 Value SetActIncidentCode (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 |
S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Kenya SHA Oncology Interventions Value Set (required) | ||||
| 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 |
S | 1..1 | SimpleQuantity(4.0.1) | Count of products or services | ||||
| unitPrice |
S | 1..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 |
S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Kenya SHA Oncology Interventions Value Set (required) | ||||
| 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 |
S | 0..1 | SimpleQuantity(4.0.1) | Count of products or services | ||||
| unitPrice |
S | 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(4.0.1) | 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 | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Claim.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| Claim.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| Claim.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| Claim.status | Base | required | Financial Resource Status Codes | 📦4.0.1 | FHIR Std. |
| Claim.type | Base | required | Claim Type Codes | 📦4.0.1 | FHIR Std. |
| Claim.subType | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.use | Base | required | Use | 📦4.0.1 | FHIR Std. |
| Claim.priority | Base | example | Process Priority Codes | 📍4.0.1 | FHIR Std. |
| Claim.fundsReserve | Base | example | FundsReserve | 📍4.0.1 | FHIR Std. |
| Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std. |
| Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std. |
| Claim.careTeam.role | Base | example | Claim Care Team Role Codes | 📍4.0.1 | FHIR Std. |
| Claim.careTeam.qualification | Base | example | Example Provider Qualification Codes | 📍4.0.1 | FHIR Std. |
| Claim.supportingInfo.category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.supportingInfo.code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std. |
| Claim.supportingInfo.reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std. |
| Claim.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std. |
| Claim.procedure.type | Base | example | Example Procedure Type Codes | 📍4.0.1 | FHIR Std. |
| Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std. |
| Claim.accident.type | Base | extensible | V3 Value SetActIncidentCode | 📦2014-03-26 | FHIR Std. |
| Claim.item.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.item.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.productOrService | Base | required | Kenya SHA Oncology Interventions Value Set | 📦0.1.0 | This IG |
| Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| Claim.item.detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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 | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Summary
Mandatory: 6 elements(3 nested mandatory elements)
Must-Support: 30 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Other representations of profile: CSV, Excel, Schematron
