nccp-oncology-claim
type: StructureDefinition
node role: treeRoot
id:
  v: nccp-oncology-claim
language:
  v: en
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: StructureDefinition nccp-oncology-claim Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Claim 0..* Claim Claim, Pre-determination or Pre-authorization #xD; meta #xD; profile S 1..* canonical(StructureDefinition) Profiles this resource claims to conform to #xD; Slices for extension 6..* Extension Extension Slice: Unordered, Open by value:url #xD; 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) #xD; 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) #xD; 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) #xD; extension:sessionExpectedDate S 1..1 date Session Expected Date Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-session-expected-date-extension #xD; extension:sessionsRequired S 1..1 integer Sessions Required Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-sessions-required-extension #xD; extension:costPerSession S 1..1 Money Cost Per Session Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-cost-per-session-extension #xD; extension:cycleNumber S 0..1 integer Cycle Number Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-cycle-number-extension #xD; extension:sessionNumber S 0..1 integer Session Number Extension URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-session-number-extension #xD; extension:regimenReference S 1..1 Reference(CarePlan) Regimen Reference Extension URL: https://nshr-uat.sha.go.ke/f…
url:
  v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-oncology-claim
  l: nccp-oncology-claim
version:
  v: 0.1.0
name:
  v: OncologyClaim
title:
  v: NCCP Oncology Claim
status:
  v: draft
date:
  v: 2026-06-04T14:49:30+00:00
publisher:
  v: Digital Health Agency (DHA), Kenya
contact:
  name:
    v: Digital Health Agency (DHA), Kenya
  telecom:
    system:
      v: url
    value:
      v: https://dha.go.ke
  telecom:
    system:
      v: email
contact:
  name:
    v: Digital Health Agency Kenya – FHIR Team
  telecom:
    system:
      v: email
    use:
      v: work
  telecom:
    system:
      v: url
    value:
      v: https://dha.go.ke
    use:
      v: work
description:
  v: Insurance claim for oncology treatment submitted to SHA, including staging, treatment setting and session details.
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
      l: 3166
    code:
      v: KE
    display:
      v: Kenya
fhir version:
  v: 4.0.1
mapping:
  identity:
    v: workflow
  uri:
    v: http://hl7.org/fhir/workflow
    l: workflow
  name:
    v: Workflow Pattern
mapping:
  identity:
    v: w5
  uri:
    v: http://hl7.org/fhir/fivews
    l: fivews
  name:
    v: FiveWs Pattern Mapping
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
    l: v3
  name:
    v: RIM Mapping
kind:
  v: resource
abstract:
  v: false
type:
  v: Claim
  l: Claim
base definition:
  v: http://hl7.org/fhir/StructureDefinition/Claim
  l: Claim
derivation:
  v: constraint
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
      l: snapshot-base-version
    value: String
      v: 4.0.1
  element:
    id:
      v: Claim
    path:
      v: Claim
    short:
      v: Claim, Pre-determination or Pre-authorization
    definition:
      v: A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.
    comment:
      v: The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.
    alias:
      v: Adjudication Request
    alias:
      v: Preauthorization Request
    alias:
      v: Predetermination Request
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: Claim
      min:
        v: 0
      max:
        v: *
    constraint:
      key:
        v: dom-2
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL NOT contain nested Resources
      expression:
        v: contained.contained.empty()
      xpath:
        v: not(parent::f:contained and f:contained)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-3
      severity:
        v: error
      human:
        v: 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
      expression:
        v: 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()
      xpath:
        v: not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-4
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
      expression:
        v: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-5
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a security label
      expression:
        v: contained.meta.security.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:security))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      extension:
        value: Boolean
      extension:
        value: Markdown
      key:
        v: dom-6
      severity:
        v: warning
      human:
        v: A resource should have narrative for robust management

Boolean
v: true

Markdown
v: When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.

v: text.`div`.exists()

v: exists(f:text/h:div)

v: false

v: false

identity:
  v: rim
map:
  v: Entity. Role, or Act

identity:
  v: workflow
map:
  v: Request

id:
  v: Claim.id
path:
  v: Claim.id
short:
  v: Logical id of this artifact
definition:
  v: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
comment:
  v: The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: id
      l: id
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: true

id:
  v: Claim.meta
path:
  v: Claim.meta
short:
  v: Metadata about the resource
definition:
  v: The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.meta
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Meta
    l: Meta
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: Claim.meta.id
path:
  v: Claim.meta.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.meta.extension
path:
  v: Claim.meta.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.meta.versionId
path:
  v: Claim.meta.versionId
short:
  v: Version specific identifier
definition:
  v: The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
comment:
  v: The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Meta.versionId
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: id
    l: id
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: Claim.meta.lastUpdated
path:
  v: Claim.meta.lastUpdated
short:
  v: When the resource version last changed
definition:
  v: When the resource last changed - e.g. when the version changed.
comment:
  v: This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http://hl7.org/fhir/R4/http.html#read) interaction.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Meta.lastUpdated
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: instant
    l: instant
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: Claim.meta.source
path:
  v: Claim.meta.source
short:
  v: Identifies where the resource comes from
definition:
  v: A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
comment:
  v: In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Meta.source
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: Claim.meta.profile
path:
  v: Claim.meta.profile
short:
  v: Profiles this resource claims to conform to
definition:
  v: A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).
comment:
  v: It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
min:
  v: 1
max:
  v: *
base:
  path:
    v: Meta.profile
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: canonical
    l: canonical
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/StructureDefinition|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/StructureDefinition
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true

id:
  v: Claim.meta.security
path:
  v: Claim.meta.security
short:
  v: Security Labels applied to this resource
definition:
  v: Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
comment:
  v: The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Meta.security
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
    l: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: SecurityLabels
  strength:
    v: extensible
  description:
    v: Security Labels from the Healthcare Privacy and Security Classification System.
  value set:
    v: http://hl7.org/fhir/ValueSet/security-labels|4.0.1
    l: http://hl7.org/fhir/ValueSet/security-labels

id:
  v: Claim.meta.tag
path:
  v: Claim.meta.tag
short:
  v: Tags applied to this resource
definition:
  v: Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
comment:
  v: The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Meta.tag
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
    l: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Tags
  strength:
    v: example
  description:
    v: Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
  value set:
    v: http://hl7.org/fhir/ValueSet/common-tags|4.0.1
    l: http://hl7.org/fhir/ValueSet/common-tags

id:
  v: Claim.implicitRules
path:
  v: Claim.implicitRules
short:
  v: A set of rules under which this content was created
definition:
  v: A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
comment:
  v: Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.implicitRules
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
is summary:
  v: true

id:
  v: Claim.language
path:
  v: Claim.language
short:
  v: Language of the resource content
definition:
  v: The base language in which the resource is written.
comment:
  v: Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.language
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
      l: elementdefinition-maxValueSet
    value: Canonical
      v: http://hl7.org/fhir/ValueSet/all-languages
      l: all-languages
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Language
  strength:
    v: preferred
  description:
    v: A human language.
  value set:
    v: http://hl7.org/fhir/ValueSet/languages|4.0.1
    l: http://hl7.org/fhir/ValueSet/languages

id:
  v: Claim.text
path:
  v: Claim.text
short:
  v: Text summary of the resource, for human interpretation
definition:
  v: A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
comment:
  v: Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
alias:
  v: narrative
alias:
  v: html
alias:
  v: xhtml
alias:
  v: display
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Narrative
    l: Narrative
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: Act.text?

id:
  v: Claim.contained
path:
  v: Claim.contained
short:
  v: Contained, inline Resources
definition:
  v: These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
comment:
  v: This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
alias:
  v: inline resources
alias:
  v: anonymous resources
alias:
  v: contained resources
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.contained
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Resource
    l: Resource
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.extension
path:
  v: Claim.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  ordered:
    v: false
  rules:
    v: open
short:
  v: Extension
definition:
  v: An Extension
min:
  v: 6
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:carcinomaStaging
path:
  v: Claim.extension
slice name:
  v: carcinomaStaging
short:
  v: Carcinoma Staging Extension
definition:
  v: Overall cancer stage for claims
min:
  v: 1
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-carcinoma-staging-extension
    l: nccp-carcinoma-staging-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:metastasesSites
path:
  v: Claim.extension
slice name:
  v: metastasesSites
short:
  v: Metastases Sites Extension
definition:
  v: Sites of metastatic disease
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-metastases-sites-extension
    l: nccp-metastases-sites-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:treatmentSetting
path:
  v: Claim.extension
slice name:
  v: treatmentSetting
short:
  v: Treatment Setting Extension
definition:
  v: Clinical setting where treatment is administered
min:
  v: 1
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-treatment-setting-extension
    l: nccp-treatment-setting-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:sessionExpectedDate
path:
  v: Claim.extension
slice name:
  v: sessionExpectedDate
short:
  v: Session Expected Date Extension
definition:
  v: Expected date of the treatment session
min:
  v: 1
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-session-expected-date-extension
    l: nccp-session-expected-date-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:sessionsRequired
path:
  v: Claim.extension
slice name:
  v: sessionsRequired
short:
  v: Sessions Required Extension
definition:
  v: Total number of sessions required for the course
min:
  v: 1
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-sessions-required-extension
    l: nccp-sessions-required-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:costPerSession
path:
  v: Claim.extension
slice name:
  v: costPerSession
short:
  v: Cost Per Session Extension
definition:
  v: Cost of a single treatment session
min:
  v: 1
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-cost-per-session-extension
    l: nccp-cost-per-session-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:cycleNumber
path:
  v: Claim.extension
slice name:
  v: cycleNumber
short:
  v: Cycle Number Extension
definition:
  v: Treatment cycle number
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-cycle-number-extension
    l: nccp-cycle-number-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:sessionNumber
path:
  v: Claim.extension
slice name:
  v: sessionNumber
short:
  v: Session Number Extension
definition:
  v: Sequential session number within a cycle
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-session-number-extension
    l: nccp-session-number-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:regimenReference
path:
  v: Claim.extension
slice name:
  v: regimenReference
short:
  v: Regimen Reference Extension
definition:
  v: Reference to the oncology care plan (regimen)
min:
  v: 1
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-regimen-reference-extension
    l: nccp-regimen-reference-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:parentAuthorization
path:
  v: Claim.extension
slice name:
  v: parentAuthorization
short:
  v: Parent Authorization Extension
definition:
  v: Reference to a parent prior authorization claim
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-parent-authorization-extension
    l: nccp-parent-authorization-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:hasCoinsurance
path:
  v: Claim.extension
slice name:
  v: hasCoinsurance
short:
  v: Has Coinsurance Extension
definition:
  v: Indicates whether coinsurance applies
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-has-coinsurance-extension
    l: nccp-has-coinsurance-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:coinsuranceDetails
path:
  v: Claim.extension
slice name:
  v: coinsuranceDetails
short:
  v: Coinsurance Details Extension
definition:
  v: Details of coinsurance arrangement
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-coinsurance-details-extension
    l: nccp-coinsurance-details-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.extension:comorbidity
path:
  v: Claim.extension
slice name:
  v: comorbidity
short:
  v: Comorbidity Extension
definition:
  v: Comorbidity information relevant to the claim
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-comorbidity-extension
    l: nccp-comorbidity-extension
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.modifierExtension
path:
  v: Claim.modifierExtension
short:
  v: Extensions that cannot be ignored
definition:
  v: May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.identifier
path:
  v: Claim.identifier
short:
  v: Business Identifier for claim
definition:
  v: A unique identifier assigned to this claim.
requirements:
  v: Allows claims to be distinguished and referenced.
alias:
  v: Claim Number
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
    l: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Request.identifier
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier

id:
  v: Claim.status
path:
  v: Claim.status
short:
  v: active | cancelled | draft | entered-in-error
definition:
  v: The status of the resource instance.
comment:
  v: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
requirements:
  v: Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.status
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/ValueSet/fm-status
    l: fm-status
mapping:
  identity:
    v: workflow
  map:
    v: Request.status
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.status

id:
  v: Claim.type
path:
  v: Claim.type
short:
  v: Category or discipline
definition:
  v: The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
comment:
  v: The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.
requirements:
  v: Claim type determine the general sets of business rules applied for information requirements and adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-type
    l: claim-type
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: Claim.subType
path:
  v: Claim.subType
short:
  v: More granular claim type
definition:
  v: A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
comment:
  v: This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.
requirements:
  v: Some jurisdictions need a finer grained claim type for routing and adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.subType
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: https://nshr-uat.sha.go.ke/fhir/ValueSet/nccp-sha-interventions-vs
    l: nccp-sha-interventions-vs
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: Claim.use
path:
  v: Claim.use
short:
  v: claim | preauthorization | predetermination
definition:
  v: A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
requirements:
  v: This element is required to understand the nature of the request for adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.use
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-use
    l: claim-use
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: Claim.patient
path:
  v: Claim.patient
short:
  v: The recipient of the products and services
definition:
  v: The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
requirements:
  v: The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.patient
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Patient
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Request.subject
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: Claim.billablePeriod
path:
  v: Claim.billablePeriod
short:
  v: Relevant time frame for the claim
definition:
  v: The period for which charges are being submitted.
comment:
  v: Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.
requirements:
  v: A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.billablePeriod
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
    l: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.done[x]

id:
  v: Claim.created
path:
  v: Claim.created
short:
  v: Resource creation date
definition:
  v: The date this resource was created.
comment:
  v: This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.
requirements:
  v: Need to record a timestamp for use by both the recipient and the issuer.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.created
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: dateTime
    l: dateTime
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Request.authoredOn
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.recorded

id:
  v: Claim.enterer
path:
  v: Claim.enterer
short:
  v: Author of the claim
definition:
  v: Individual who created the claim, predetermination or preauthorization.
requirements:
  v: Some jurisdictions require the contact information for personnel completing claims.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.enterer
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Practitioner
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/PractitionerRole
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.author

id:
  v: Claim.insurer
path:
  v: Claim.insurer
short:
  v: Target
definition:
  v: The Insurer who is target of the request.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.insurer
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Request.performer

id:
  v: Claim.provider
path:
  v: Claim.provider
short:
  v: Party responsible for the claim
definition:
  v: The provider which is responsible for the claim, predetermination or preauthorization.
comment:
  v: Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.provider
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Practitioner
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/PractitionerRole
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Request.requester
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.source

id:
  v: Claim.priority
path:
  v: Claim.priority
short:
  v: Desired processing ugency
definition:
  v: The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
comment:
  v: If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.
requirements:
  v: The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.priority
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProcessPriority
  strength:
    v: example
  description:
    v: The timeliness with which processing is required: stat, normal, deferred.
  value set:
    v: http://hl7.org/fhir/ValueSet/process-priority|4.0.1
    l: http://hl7.org/fhir/ValueSet/process-priority
mapping:
  identity:
    v: workflow
  map:
    v: Request.priority

id:
  v: Claim.fundsReserve
path:
  v: Claim.fundsReserve
short:
  v: For whom to reserve funds
definition:
  v: A code to indicate whether and for whom funds are to be reserved for future claims.
comment:
  v: This field is only used for preauthorizations.
requirements:
  v: In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.
alias:
  v: Fund pre-allocation
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.fundsReserve
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: FundsReserve
  strength:
    v: example
  description:
    v: For whom funds are to be reserved: (Patient, Provider, None).
  value set:
    v: http://hl7.org/fhir/ValueSet/fundsreserve|4.0.1
    l: http://hl7.org/fhir/ValueSet/fundsreserve

id:
  v: Claim.related
path:
  v: Claim.related
short:
  v: Prior or corollary claims
definition:
  v: Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
comment:
  v: For example, for the original treatment and follow-up exams.
requirements:
  v: For workplace or other accidents it is common to relate separate claims arising from the same event.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.related
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.related.id
path:
  v: Claim.related.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.related.extension
path:
  v: Claim.related.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.related.modifierExtension
path:
  v: Claim.related.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.related.claim
path:
  v: Claim.related.claim
short:
  v: Reference to the related claim
definition:
  v: Reference to a related claim.
requirements:
  v: For workplace or other accidents it is common to relate separate claims arising from the same event.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.related.claim
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Claim|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Claim
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Request.replaces

id:
  v: Claim.related.relationship
path:
  v: Claim.related.relationship
short:
  v: How the reference claim is related
definition:
  v: A code to convey how the claims are related.
comment:
  v: For example, prior claim or umbrella.
requirements:
  v: Some insurers need a declaration of the type of relationship.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.related.relationship
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RelatedClaimRelationship
  strength:
    v: example
  description:
    v: Relationship of this claim to a related Claim.
  value set:
    v: http://hl7.org/fhir/ValueSet/related-claim-relationship|4.0.1
    l: http://hl7.org/fhir/ValueSet/related-claim-relationship

id:
  v: Claim.related.reference
path:
  v: Claim.related.reference
short:
  v: File or case reference
definition:
  v: An alternate organizational reference to the case or file to which this particular claim pertains.
comment:
  v: For example, Property/Casualty insurer claim # or Workers Compensation case # .
requirements:
  v: In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.related.reference
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
    l: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.prescription
path:
  v: Claim.prescription
short:
  v: Prescription authorizing services and products
definition:
  v: Prescription to support the dispensing of pharmacy, device or vision products.
requirements:
  v: Required to authorize the dispensing of controlled substances and devices.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.prescription
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/DeviceRequest|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/DeviceRequest
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/MedicationRequest|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/VisionPrescription|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/VisionPrescription
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.originalPrescription
path:
  v: Claim.originalPrescription
short:
  v: Original prescription if superseded by fulfiller
definition:
  v: Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
comment:
  v: For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
requirements:
  v: Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.originalPrescription
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/DeviceRequest|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/DeviceRequest
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/MedicationRequest|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/VisionPrescription|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/VisionPrescription
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.payee
path:
  v: Claim.payee
short:
  v: Recipient of benefits payable
definition:
  v: The party to be reimbursed for cost of the products and services according to the terms of the policy.
comment:
  v: Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead.
requirements:
  v: The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.payee
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.payee.id
path:
  v: Claim.payee.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.payee.extension
path:
  v: Claim.payee.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.payee.modifierExtension
path:
  v: Claim.payee.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.payee.type
path:
  v: Claim.payee.type
short:
  v: Category of recipient
definition:
  v: Type of Party to be reimbursed: subscriber, provider, other.
requirements:
  v: Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.payee.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: PayeeType
  strength:
    v: example
  description:
    v: A code for the party to be reimbursed.
  value set:
    v: http://hl7.org/fhir/ValueSet/payeetype|4.0.1
    l: http://hl7.org/fhir/ValueSet/payeetype

id:
  v: Claim.payee.party
path:
  v: Claim.payee.party
short:
  v: Recipient reference
definition:
  v: Reference to the individual or organization to whom any payment will be made.
comment:
  v: Not required if the payee is 'subscriber' or 'provider'.
requirements:
  v: Need to provide demographics if the payee is not 'subscriber' nor 'provider'.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.payee.party
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Practitioner
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/PractitionerRole
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Organization
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Patient
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/RelatedPerson|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/RelatedPerson
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.referral
path:
  v: Claim.referral
short:
  v: Treatment referral
definition:
  v: A reference to a referral resource.
comment:
  v: The referral resource which lists the date, practitioner, reason and other supporting information.
requirements:
  v: Some insurers require proof of referral to pay for services or to pay specialist rates for services.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.referral
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/ServiceRequest|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/ServiceRequest
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.cause

id:
  v: Claim.facility
path:
  v: Claim.facility
short:
  v: Servicing facility
definition:
  v: Facility where the services were provided.
requirements:
  v: Insurance adjudication can be dependant on where services were delivered.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.facility
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Location
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.where[x]

id:
  v: Claim.careTeam
path:
  v: Claim.careTeam
short:
  v: Members of the care team
definition:
  v: The members of the team who provided the products and services.
requirements:
  v: Common to identify the responsible and supporting practitioners.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.careTeam
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.careTeam.id
path:
  v: Claim.careTeam.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.careTeam.extension
path:
  v: Claim.careTeam.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.careTeam.modifierExtension
path:
  v: Claim.careTeam.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.careTeam.sequence
path:
  v: Claim.careTeam.sequence
short:
  v: Order of care team
definition:
  v: A number to uniquely identify care team entries.
requirements:
  v: Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.careTeam.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.careTeam.provider
path:
  v: Claim.careTeam.provider
short:
  v: Practitioner or organization
definition:
  v: Member of the team who provided the product or service.
requirements:
  v: Often a regulatory requirement to specify the responsible provider.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.careTeam.provider
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Practitioner
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/PractitionerRole
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.actor

id:
  v: Claim.careTeam.responsible
path:
  v: Claim.careTeam.responsible
short:
  v: Indicator of the lead practitioner
definition:
  v: The party who is billing and/or responsible for the claimed products or services.
comment:
  v: Responsible might not be required when there is only a single provider listed.
requirements:
  v: When multiple parties are present it is required to distinguish the lead or responsible individual.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.careTeam.responsible
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.careTeam.role
path:
  v: Claim.careTeam.role
short:
  v: Function within the team
definition:
  v: The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
comment:
  v: Role might not be required when there is only a single provider listed.
requirements:
  v: When multiple parties are present it is required to distinguish the roles performed by each member.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.careTeam.role
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: CareTeamRole
  strength:
    v: example
  description:
    v: The role codes for the care team members.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-careteamrole|4.0.1
    l: http://hl7.org/fhir/ValueSet/claim-careteamrole

id:
  v: Claim.careTeam.qualification
path:
  v: Claim.careTeam.qualification
short:
  v: Practitioner credential or specialization
definition:
  v: The qualification of the practitioner which is applicable for this service.
requirements:
  v: Need to specify which qualification a provider is delivering the product or service under.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.careTeam.qualification
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProviderQualification
  strength:
    v: example
  description:
    v: Provider professional qualifications.
  value set:
    v: http://hl7.org/fhir/ValueSet/provider-qualification|4.0.1
    l: http://hl7.org/fhir/ValueSet/provider-qualification

id:
  v: Claim.supportingInfo
path:
  v: Claim.supportingInfo
short:
  v: Supporting information
definition:
  v: Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
comment:
  v: Often there are multiple jurisdiction specific valuesets which are required.
requirements:
  v: Typically these information codes are required to support the services rendered or the adjudication of the services rendered.
alias:
  v: Attachments Exception Codes Occurrence Codes Value codes
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.supportingInfo
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Request.supportingInfo

id:
  v: Claim.supportingInfo.id
path:
  v: Claim.supportingInfo.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.supportingInfo.extension
path:
  v: Claim.supportingInfo.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.supportingInfo.modifierExtension
path:
  v: Claim.supportingInfo.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.supportingInfo.sequence
path:
  v: Claim.supportingInfo.sequence
short:
  v: Information instance identifier
definition:
  v: A number to uniquely identify supporting information entries.
requirements:
  v: Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.supportingInfo.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.supportingInfo.category
path:
  v: Claim.supportingInfo.category
short:
  v: Classification of the supplied information
definition:
  v: The general class of the information supplied: information; exception; accident, employment; onset, etc.
comment:
  v: This may contain a category for the local bill type codes.
requirements:
  v: Required to group or associate information items with common characteristics. For example: admission information or prior treatments.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.supportingInfo.category
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: InformationCategory
  strength:
    v: example
  description:
    v: The valuset used for additional information category codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-informationcategory|4.0.1
    l: http://hl7.org/fhir/ValueSet/claim-informationcategory

id:
  v: Claim.supportingInfo.code
path:
  v: Claim.supportingInfo.code
short:
  v: Type of information
definition:
  v: System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
requirements:
  v: Required to identify the kind of additional information.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.supportingInfo.code
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: InformationCode
  strength:
    v: example
  description:
    v: The valuset used for additional information codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-exception|4.0.1
    l: http://hl7.org/fhir/ValueSet/claim-exception

id:
  v: Claim.supportingInfo.timing[x]
path:
  v: Claim.supportingInfo.timing[x]
short:
  v: When it occurred
definition:
  v: The date when or period to which this information refers.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.supportingInfo.timing[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
    l: date
type:
  code:
    v: Period
    l: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.supportingInfo.value[x]
path:
  v: Claim.supportingInfo.value[x]
short:
  v: Data to be provided
definition:
  v: Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
comment:
  v: Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.
requirements:
  v: To convey the data content to be provided when the information is more than a simple code or period.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.supportingInfo.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean
type:
  code:
    v: string
    l: string
type:
  code:
    v: Quantity
    l: Quantity
type:
  code:
    v: Attachment
    l: Attachment
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Resource|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Resource
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.supportingInfo.reason
path:
  v: Claim.supportingInfo.reason
short:
  v: Explanation for the information
definition:
  v: Provides the reason in the situation where a reason code is required in addition to the content.
comment:
  v: For example: the reason for the additional stay, or why a tooth is missing.
requirements:
  v: Needed when the supporting information has both a date and amount/value and requires explanation.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.supportingInfo.reason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: MissingReason
  strength:
    v: example
  description:
    v: Reason codes for the missing teeth.
  value set:
    v: http://hl7.org/fhir/ValueSet/missing-tooth-reason|4.0.1
    l: http://hl7.org/fhir/ValueSet/missing-tooth-reason

id:
  v: Claim.diagnosis
path:
  v: Claim.diagnosis
short:
  v: Pertinent diagnosis information
definition:
  v: Information about diagnoses relevant to the claim items.
requirements:
  v: Required for the adjudication by provided context for the services and product listed.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.diagnosis
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Request.reasonReference

id:
  v: Claim.diagnosis.id
path:
  v: Claim.diagnosis.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.diagnosis.extension
path:
  v: Claim.diagnosis.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.diagnosis.modifierExtension
path:
  v: Claim.diagnosis.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.diagnosis.sequence
path:
  v: Claim.diagnosis.sequence
short:
  v: Diagnosis instance identifier
definition:
  v: A number to uniquely identify diagnosis entries.
comment:
  v: Diagnosis are presented in list order to their expected importance: primary, secondary, etc.
requirements:
  v: Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.diagnosis.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.diagnosis.diagnosis[x]
path:
  v: Claim.diagnosis.diagnosis[x]
slicing:
  discriminator:
    type:
      v: type
    path:
      v: $this
  ordered:
    v: false
  rules:
    v: open
short:
  v: Nature of illness or problem
definition:
  v: The nature of illness or problem in a coded form or as a reference to an external defined Condition.
requirements:
  v: Provides health context for the evaluation of the products and/or services.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.diagnosis.diagnosis[x]
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Condition|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Condition
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ICD10
  strength:
    v: example
  description:
    v: Example ICD10 Diagnostic codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/icd-10|4.0.1
    l: http://hl7.org/fhir/ValueSet/icd-10

id:
  v: Claim.diagnosis.diagnosis[x]:diagnosisReference
path:
  v: Claim.diagnosis.diagnosis[x]
slice name:
  v: diagnosisReference
short:
  v: Nature of illness or problem
definition:
  v: The nature of illness or problem in a coded form or as a reference to an external defined Condition.
requirements:
  v: Provides health context for the evaluation of the products and/or services.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.diagnosis.diagnosis[x]
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/nccp-oncology-diagnosis-condition
    l: nccp-oncology-diagnosis-condition
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.diagnosis.type
path:
  v: Claim.diagnosis.type
short:
  v: Timing or nature of the diagnosis
definition:
  v: When the condition was observed or the relative ranking.
comment:
  v: For example: admitting, primary, secondary, discharge.
requirements:
  v: Often required to capture a particular diagnosis, for example: primary or discharge.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.diagnosis.type
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: DiagnosisType
  strength:
    v: example
  description:
    v: The type of the diagnosis: admitting, principal, discharge.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-diagnosistype|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-diagnosistype

id:
  v: Claim.diagnosis.onAdmission
path:
  v: Claim.diagnosis.onAdmission
short:
  v: Present on admission
definition:
  v: Indication of whether the diagnosis was present on admission to a facility.
requirements:
  v: Many systems need to understand for adjudication if the diagnosis was present a time of admission.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.diagnosis.onAdmission
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: DiagnosisOnAdmission
  strength:
    v: example
  description:
    v: Present on admission.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission

id:
  v: Claim.diagnosis.packageCode
path:
  v: Claim.diagnosis.packageCode
short:
  v: Package billing code
definition:
  v: A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.
comment:
  v: For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.
requirements:
  v: Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.diagnosis.packageCode
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: DiagnosisRelatedGroup
  strength:
    v: example
  description:
    v: The DRG codes associated with the diagnosis.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup

id:
  v: Claim.procedure
path:
  v: Claim.procedure
short:
  v: Clinical procedures performed
definition:
  v: Procedures performed on the patient relevant to the billing items with the claim.
requirements:
  v: The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.procedure
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.procedure.id
path:
  v: Claim.procedure.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.procedure.extension
path:
  v: Claim.procedure.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.procedure.modifierExtension
path:
  v: Claim.procedure.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.procedure.sequence
path:
  v: Claim.procedure.sequence
short:
  v: Procedure instance identifier
definition:
  v: A number to uniquely identify procedure entries.
requirements:
  v: Necessary to provide a mechanism to link to claim details.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.procedure.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.procedure.type
path:
  v: Claim.procedure.type
short:
  v: Category of Procedure
definition:
  v: When the condition was observed or the relative ranking.
comment:
  v: For example: primary, secondary.
requirements:
  v: Often required to capture a particular diagnosis, for example: primary or discharge.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.procedure.type
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProcedureType
  strength:
    v: example
  description:
    v: Example procedure type codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-procedure-type|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-procedure-type

id:
  v: Claim.procedure.date
path:
  v: Claim.procedure.date
short:
  v: When the procedure was performed
definition:
  v: Date and optionally time the procedure was performed.
requirements:
  v: Required for auditing purposes.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.procedure.date
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: dateTime
    l: dateTime
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.procedure.procedure[x]
path:
  v: Claim.procedure.procedure[x]
short:
  v: Specific clinical procedure
definition:
  v: The code or reference to a Procedure resource which identifies the clinical intervention performed.
requirements:
  v: This identifies the actual clinical procedure.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.procedure.procedure[x]
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Procedure|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Procedure
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ICD10_Procedures
  strength:
    v: example
  description:
    v: Example ICD10 Procedure codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/icd-10-procedures|4.0.1
    l: http://hl7.org/fhir/ValueSet/icd-10-procedures

id:
  v: Claim.procedure.udi
path:
  v: Claim.procedure.udi
short:
  v: Unique device identifier
definition:
  v: Unique Device Identifiers associated with this line item.
requirements:
  v: The UDI code allows the insurer to obtain device level information on the product supplied.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.procedure.udi
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Device
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.insurance
path:
  v: Claim.insurance
short:
  v: Patient insurance information
definition:
  v: Financial instruments for reimbursement for the health care products and services specified on the claim.
comment:
  v: All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
requirements:
  v: At least one insurer is required for a claim to be a claim.
min:
  v: 1
max:
  v: *
base:
  path:
    v: Claim.insurance
  min:
    v: 1
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: Coverage

id:
  v: Claim.insurance.id
path:
  v: Claim.insurance.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.insurance.extension
path:
  v: Claim.insurance.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.insurance.modifierExtension
path:
  v: Claim.insurance.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.insurance.sequence
path:
  v: Claim.insurance.sequence
short:
  v: Insurance instance identifier
definition:
  v: A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
requirements:
  v: To maintain order of the coverages.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.insurance.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: Claim.insurance.focal
path:
  v: Claim.insurance.focal
short:
  v: Coverage to be used for adjudication
definition:
  v: A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
comment:
  v: A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.
requirements:
  v: To identify which coverage in the list is being used to adjudicate this claim.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.insurance.focal
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: Claim.insurance.identifier
path:
  v: Claim.insurance.identifier
short:
  v: Pre-assigned Claim number
definition:
  v: The business identifier to be used when the claim is sent for adjudication against this insurance policy.
comment:
  v: Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'.
requirements:
  v: This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.insurance.identifier
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
    l: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Request.identifier
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier

id:
  v: Claim.insurance.coverage
path:
  v: Claim.insurance.coverage
short:
  v: Insurance information
definition:
  v: Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
requirements:
  v: Required to allow the adjudicator to locate the correct policy and history within their information system.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.insurance.coverage
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Coverage|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Coverage
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true

id:
  v: Claim.insurance.businessArrangement
path:
  v: Claim.insurance.businessArrangement
short:
  v: Additional provider contract number
definition:
  v: A business agreement number established between the provider and the insurer for special business processing purposes.
requirements:
  v: Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.insurance.businessArrangement
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.insurance.preAuthRef
path:
  v: Claim.insurance.preAuthRef
short:
  v: Prior authorization reference number
definition:
  v: Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
comment:
  v: This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.
requirements:
  v: Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.insurance.preAuthRef
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.insurance.claimResponse
path:
  v: Claim.insurance.claimResponse
short:
  v: Adjudication results
definition:
  v: The result of the adjudication of the line items for the Coverage specified in this insurance.
comment:
  v: Must not be specified when 'focal=true' for this insurance.
requirements:
  v: An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.insurance.claimResponse
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/ClaimResponse|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/ClaimResponse
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.accident
path:
  v: Claim.accident
short:
  v: Details of the event
definition:
  v: Details of an accident which resulted in injuries which required the products and services listed in the claim.
requirements:
  v: When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.accident
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.accident.id
path:
  v: Claim.accident.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.accident.extension
path:
  v: Claim.accident.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.accident.modifierExtension
path:
  v: Claim.accident.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.accident.date
path:
  v: Claim.accident.date
short:
  v: When the incident occurred
definition:
  v: Date of an accident event related to the products and services contained in the claim.
comment:
  v: The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.
requirements:
  v: Required for audit purposes and adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.accident.date
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: date
    l: date
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.accident.type
path:
  v: Claim.accident.type
short:
  v: The nature of the accident
definition:
  v: The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.
requirements:
  v: Coverage may be dependant on the type of accident.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.accident.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: AccidentType
  strength:
    v: extensible
  description:
    v: Type of accident: work place, auto, etc.
  value set:
    v: http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
    l: v3-ActIncidentCode

id:
  v: Claim.accident.location[x]
path:
  v: Claim.accident.location[x]
short:
  v: Where the event occurred
definition:
  v: The physical location of the accident event.
requirements:
  v: Required for audit purposes and determination of applicable insurance liability.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.accident.location[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Address
    l: Address
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Location
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item
path:
  v: Claim.item
short:
  v: Product or service provided
definition:
  v: A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
requirements:
  v: The items to be processed for adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.id
path:
  v: Claim.item.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.item.extension
path:
  v: Claim.item.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.item.modifierExtension
path:
  v: Claim.item.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.item.sequence
path:
  v: Claim.item.sequence
short:
  v: Item instance identifier
definition:
  v: A number to uniquely identify item entries.
requirements:
  v: Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.item.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.careTeamSequence
path:
  v: Claim.item.careTeamSequence
short:
  v: Applicable careTeam members
definition:
  v: CareTeam members related to this service or product.
requirements:
  v: Need to identify the individuals and their roles in the provision of the product or service.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.careTeamSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.diagnosisSequence
path:
  v: Claim.item.diagnosisSequence
short:
  v: Applicable diagnoses
definition:
  v: Diagnosis applicable for this service or product.
requirements:
  v: Need to related the product or service to the associated diagnoses.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.diagnosisSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.procedureSequence
path:
  v: Claim.item.procedureSequence
short:
  v: Applicable procedures
definition:
  v: Procedures applicable for this service or product.
requirements:
  v: Need to provide any listed specific procedures to support the product or service being claimed.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.procedureSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.informationSequence
path:
  v: Claim.item.informationSequence
short:
  v: Applicable exception and supporting information
definition:
  v: Exceptions, special conditions and supporting information applicable for this service or product.
requirements:
  v: Need to reference the supporting information items that relate directly to this product or service.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.informationSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.revenue
path:
  v: Claim.item.revenue
short:
  v: Revenue or cost center code
definition:
  v: The type of revenue or cost center providing the product and/or service.
requirements:
  v: Needed in the processing of institutional claims.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.revenue
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RevenueCenter
  strength:
    v: example
  description:
    v: Codes for the revenue or cost centers supplying the service and/or products.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-revenue-center|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-revenue-center

id:
  v: Claim.item.category
path:
  v: Claim.item.category
short:
  v: Benefit classification
definition:
  v: Code to identify the general type of benefits under which products and services are provided.
comment:
  v: Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
requirements:
  v: Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitCategory
  strength:
    v: example
  description:
    v: Benefit categories such as: oral-basic, major, glasses.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-benefitcategory|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-benefitcategory

id:
  v: Claim.item.productOrService
path:
  v: Claim.item.productOrService
short:
  v: Billing, service, product, or drug code
definition:
  v: When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
comment:
  v: If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
requirements:
  v: Necessary to state what was provided or done.
alias:
  v: Drug Code
alias:
  v: Bill Code
alias:
  v: Service Code
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.item.productOrService
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: https://nshr-uat.sha.go.ke/fhir/ValueSet/nccp-sha-interventions-vs
    l: nccp-sha-interventions-vs

id:
  v: Claim.item.modifier
path:
  v: Claim.item.modifier
short:
  v: Product or service billing modifiers
definition:
  v: Item typification or modifiers codes to convey additional context for the product or service.
comment:
  v: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
requirements:
  v: To support inclusion of the item for adjudication or to charge an elevated fee.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-modifiers|4.0.1
    l: http://hl7.org/fhir/ValueSet/claim-modifiers

id:
  v: Claim.item.programCode
path:
  v: Claim.item.programCode
short:
  v: Program the product or service is provided under
definition:
  v: Identifies the program under which this may be recovered.
comment:
  v: For example: Neonatal program, child dental program or drug users recovery program.
requirements:
  v: Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.programCode
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProgramCode
  strength:
    v: example
  description:
    v: Program specific reason codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-program-code|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-program-code

id:
  v: Claim.item.serviced[x]
path:
  v: Claim.item.serviced[x]
short:
  v: Date or dates of service or product delivery
definition:
  v: The date or dates when the service or product was supplied, performed or completed.
requirements:
  v: Needed to determine whether the service or product was provided during the term of the insurance coverage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.serviced[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
    l: date
type:
  code:
    v: Period
    l: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.done[x]

id:
  v: Claim.item.location[x]
path:
  v: Claim.item.location[x]
short:
  v: Place of service or where product was supplied
definition:
  v: Where the product or service was provided.
requirements:
  v: The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.location[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
type:
  code:
    v: Address
    l: Address
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Location
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ServicePlace
  strength:
    v: example
  description:
    v: Place of service: pharmacy, school, prison, etc.
  value set:
    v: http://hl7.org/fhir/ValueSet/service-place|4.0.1
    l: http://hl7.org/fhir/ValueSet/service-place
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.where[x]

id:
  v: Claim.item.quantity
path:
  v: Claim.item.quantity
short:
  v: Count of products or services
definition:
  v: The number of repetitions of a service or product.
requirements:
  v: Required when the product or service code does not convey the quantity provided.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.item.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.unitPrice
path:
  v: Claim.item.unitPrice
short:
  v: Fee, charge or cost per item
definition:
  v: If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
requirements:
  v: The amount charged to the patient by the provider for a single unit.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.item.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.factor
path:
  v: Claim.item.factor
short:
  v: Price scaling factor
definition:
  v: A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
comment:
  v: To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
requirements:
  v: When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
    l: decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.net
path:
  v: Claim.item.net
short:
  v: Total item cost
definition:
  v: The quantity times the unit price for an additional service or product or charge.
comment:
  v: For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
requirements:
  v: Provides the total amount claimed for the group (if a grouper) or the line item.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.udi
path:
  v: Claim.item.udi
short:
  v: Unique device identifier
definition:
  v: Unique Device Identifiers associated with this line item.
requirements:
  v: The UDI code allows the insurer to obtain device level information on the product supplied.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.udi
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Device
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.bodySite
path:
  v: Claim.item.bodySite
short:
  v: Anatomical location
definition:
  v: Physical service site on the patient (limb, tooth, etc.).
comment:
  v: For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.
requirements:
  v: Allows insurer to validate specific procedures.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.bodySite
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: OralSites
  strength:
    v: example
  description:
    v: The code for the teeth, quadrant, sextant and arch.
  value set:
    v: http://hl7.org/fhir/ValueSet/tooth|4.0.1
    l: http://hl7.org/fhir/ValueSet/tooth

id:
  v: Claim.item.subSite
path:
  v: Claim.item.subSite
short:
  v: Anatomical sub-location
definition:
  v: A region or surface of the bodySite, e.g. limb region or tooth surface(s).
requirements:
  v: Allows insurer to validate specific procedures.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.subSite
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Surface
  strength:
    v: example
  description:
    v: The code for the tooth surface and surface combinations.
  value set:
    v: http://hl7.org/fhir/ValueSet/surface|4.0.1
    l: http://hl7.org/fhir/ValueSet/surface

id:
  v: Claim.item.encounter
path:
  v: Claim.item.encounter
short:
  v: Encounters related to this billed item
definition:
  v: The Encounters during which this Claim was created or to which the creation of this record is tightly associated.
comment:
  v: This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
requirements:
  v: Used in some jurisdictions to link clinical events to claim items.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.encounter
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Encounter|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Encounter
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Request.context

id:
  v: Claim.item.detail
path:
  v: Claim.item.detail
short:
  v: Product or service provided
definition:
  v: A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
requirements:
  v: The items to be processed for adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.detail
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.id
path:
  v: Claim.item.detail.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.item.detail.extension
path:
  v: Claim.item.detail.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.item.detail.modifierExtension
path:
  v: Claim.item.detail.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.item.detail.sequence
path:
  v: Claim.item.detail.sequence
short:
  v: Item instance identifier
definition:
  v: A number to uniquely identify item entries.
requirements:
  v: Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.item.detail.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.revenue
path:
  v: Claim.item.detail.revenue
short:
  v: Revenue or cost center code
definition:
  v: The type of revenue or cost center providing the product and/or service.
requirements:
  v: Needed in the processing of institutional claims.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.revenue
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RevenueCenter
  strength:
    v: example
  description:
    v: Codes for the revenue or cost centers supplying the service and/or products.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-revenue-center|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-revenue-center

id:
  v: Claim.item.detail.category
path:
  v: Claim.item.detail.category
short:
  v: Benefit classification
definition:
  v: Code to identify the general type of benefits under which products and services are provided.
comment:
  v: Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
requirements:
  v: Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitCategory
  strength:
    v: example
  description:
    v: Benefit categories such as: oral-basic, major, glasses.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-benefitcategory|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-benefitcategory

id:
  v: Claim.item.detail.productOrService
path:
  v: Claim.item.detail.productOrService
short:
  v: Billing, service, product, or drug code
definition:
  v: When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
comment:
  v: If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
requirements:
  v: Necessary to state what was provided or done.
alias:
  v: Drug Code
alias:
  v: Bill Code
alias:
  v: Service Code
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.item.detail.productOrService
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: https://nshr-uat.sha.go.ke/fhir/ValueSet/nccp-sha-interventions-vs
    l: nccp-sha-interventions-vs

id:
  v: Claim.item.detail.modifier
path:
  v: Claim.item.detail.modifier
short:
  v: Service/Product billing modifiers
definition:
  v: Item typification or modifiers codes to convey additional context for the product or service.
comment:
  v: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
requirements:
  v: To support inclusion of the item for adjudication or to charge an elevated fee.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.detail.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-modifiers|4.0.1
    l: http://hl7.org/fhir/ValueSet/claim-modifiers

id:
  v: Claim.item.detail.programCode
path:
  v: Claim.item.detail.programCode
short:
  v: Program the product or service is provided under
definition:
  v: Identifies the program under which this may be recovered.
comment:
  v: For example: Neonatal program, child dental program or drug users recovery program.
requirements:
  v: Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.detail.programCode
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProgramCode
  strength:
    v: example
  description:
    v: Program specific reason codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-program-code|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-program-code

id:
  v: Claim.item.detail.quantity
path:
  v: Claim.item.detail.quantity
short:
  v: Count of products or services
definition:
  v: The number of repetitions of a service or product.
requirements:
  v: Required when the product or service code does not convey the quantity provided.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.unitPrice
path:
  v: Claim.item.detail.unitPrice
short:
  v: Fee, charge or cost per item
definition:
  v: If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
requirements:
  v: The amount charged to the patient by the provider for a single unit.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.factor
path:
  v: Claim.item.detail.factor
short:
  v: Price scaling factor
definition:
  v: A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
comment:
  v: To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
requirements:
  v: When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
    l: decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.net
path:
  v: Claim.item.detail.net
short:
  v: Total item cost
definition:
  v: The quantity times the unit price for an additional service or product or charge.
comment:
  v: For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
requirements:
  v: Provides the total amount claimed for the group (if a grouper) or the line item.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.udi
path:
  v: Claim.item.detail.udi
short:
  v: Unique device identifier
definition:
  v: Unique Device Identifiers associated with this line item.
requirements:
  v: The UDI code allows the insurer to obtain device level information on the product supplied.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.detail.udi
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Device
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.subDetail
path:
  v: Claim.item.detail.subDetail
short:
  v: Product or service provided
definition:
  v: A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
requirements:
  v: The items to be processed for adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.detail.subDetail
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.subDetail.id
path:
  v: Claim.item.detail.subDetail.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.item.detail.subDetail.extension
path:
  v: Claim.item.detail.subDetail.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Claim.item.detail.subDetail.modifierExtension
path:
  v: Claim.item.detail.subDetail.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Claim.item.detail.subDetail.sequence
path:
  v: Claim.item.detail.subDetail.sequence
short:
  v: Item instance identifier
definition:
  v: A number to uniquely identify item entries.
requirements:
  v: Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.item.detail.subDetail.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.subDetail.revenue
path:
  v: Claim.item.detail.subDetail.revenue
short:
  v: Revenue or cost center code
definition:
  v: The type of revenue or cost center providing the product and/or service.
requirements:
  v: Needed in the processing of institutional claims.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.subDetail.revenue
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RevenueCenter
  strength:
    v: example
  description:
    v: Codes for the revenue or cost centers supplying the service and/or products.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-revenue-center|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-revenue-center

id:
  v: Claim.item.detail.subDetail.category
path:
  v: Claim.item.detail.subDetail.category
short:
  v: Benefit classification
definition:
  v: Code to identify the general type of benefits under which products and services are provided.
comment:
  v: Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
requirements:
  v: Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.subDetail.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitCategory
  strength:
    v: example
  description:
    v: Benefit categories such as: oral-basic, major, glasses.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-benefitcategory|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-benefitcategory

id:
  v: Claim.item.detail.subDetail.productOrService
path:
  v: Claim.item.detail.subDetail.productOrService
short:
  v: Billing, service, product, or drug code
definition:
  v: When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
comment:
  v: If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
requirements:
  v: Necessary to state what was provided or done.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Claim.item.detail.subDetail.productOrService
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/service-uscls|4.0.1
    l: http://hl7.org/fhir/ValueSet/service-uscls

id:
  v: Claim.item.detail.subDetail.modifier
path:
  v: Claim.item.detail.subDetail.modifier
short:
  v: Service/Product billing modifiers
definition:
  v: Item typification or modifiers codes to convey additional context for the product or service.
comment:
  v: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
requirements:
  v: To support inclusion of the item for adjudication or to charge an elevated fee.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.detail.subDetail.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-modifiers|4.0.1
    l: http://hl7.org/fhir/ValueSet/claim-modifiers

id:
  v: Claim.item.detail.subDetail.programCode
path:
  v: Claim.item.detail.subDetail.programCode
short:
  v: Program the product or service is provided under
definition:
  v: Identifies the program under which this may be recovered.
comment:
  v: For example: Neonatal program, child dental program or drug users recovery program.
requirements:
  v: Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.detail.subDetail.programCode
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProgramCode
  strength:
    v: example
  description:
    v: Program specific reason codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-program-code|4.0.1
    l: http://hl7.org/fhir/ValueSet/ex-program-code

id:
  v: Claim.item.detail.subDetail.quantity
path:
  v: Claim.item.detail.subDetail.quantity
short:
  v: Count of products or services
definition:
  v: The number of repetitions of a service or product.
requirements:
  v: Required when the product or service code does not convey the quantity provided.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.subDetail.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.subDetail.unitPrice
path:
  v: Claim.item.detail.subDetail.unitPrice
short:
  v: Fee, charge or cost per item
definition:
  v: If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
requirements:
  v: The amount charged to the patient by the provider for a single unit.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.subDetail.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.subDetail.factor
path:
  v: Claim.item.detail.subDetail.factor
short:
  v: Price scaling factor
definition:
  v: A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
comment:
  v: To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
requirements:
  v: When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.subDetail.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
    l: decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.subDetail.net
path:
  v: Claim.item.detail.subDetail.net
short:
  v: Total item cost
definition:
  v: The quantity times the unit price for an additional service or product or charge.
comment:
  v: For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
requirements:
  v: Provides the total amount claimed for the group (if a grouper) or the line item.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.item.detail.subDetail.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.item.detail.subDetail.udi
path:
  v: Claim.item.detail.subDetail.udi
short:
  v: Unique device identifier
definition:
  v: Unique Device Identifiers associated with this line item.
requirements:
  v: The UDI code allows the insurer to obtain device level information on the product supplied.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Claim.item.detail.subDetail.udi
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Device
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Claim.total
path:
  v: Claim.total
short:
  v: Total claim cost
definition:
  v: The total value of the all the items in the claim.
requirements:
  v: Used for control total purposes.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Claim.total
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

element:
  id:
    v: Claim
  path:
    v: Claim