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. 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. If the element is present, it must have either a @value, an @id, or extensions A unique identifier assigned to this claim. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. The status of the resource instance. Used to indicate why the status has changed. The category of claim, e.g. oral, pharmacy, vision, institutional, professional. A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided. The party/group to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought. The period for which charges are being submitted. The date this resource was created. Individual who created the claim, predetermination or preauthorization. The Insurer who is target of the request. The provider which is responsible for the claim, predetermination or preauthorization. The provider-required urgency of processing the request. Typical values include: stat, normal, deferred. A code to indicate whether and for whom funds are to be reserved for future claims. Other claims which are related to this claim such as prior submissions or claims for related services or for the same event. Prescription is the document/authorization given to the claim author for them to provide products and services for which consideration (reimbursement) is sought. Could be a RX for medications, an 'order' for oxygen or wheelchair or physiotherapy treatments. Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. The party to be reimbursed for cost of the products and services according to the terms of the policy. The referral information received by the claim author, it is not to be used when the author generates a referral for a patient. A copy of that referral may be provided as supporting information. Some insurers require proof of referral to pay for services or to pay specialist rates for services. Healthcare encounters related to this claim. Facility where the services were provided. 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. Information code for an event with a corresponding date or period. The members of the team who provided the products and services. Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Information about diagnoses relevant to the claim items. Procedures performed on the patient relevant to the billing items with the claim. Financial instruments for reimbursement for the health care products and services specified on the claim. Details of an accident which resulted in injuries which required the products and services listed in the claim. The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services. 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. The total value of the all the items in the claim. 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. Reference to a related claim. A code to convey how the claims are related. An alternate organizational reference to the case or file to which this particular claim pertains. 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. Type of Party to be reimbursed: subscriber, provider, other. Reference to the individual or organization to whom any payment will be made. 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. A coded event such as when a service is expected or a card printed. A date or period in the past or future indicating when the event occurred or is expectd to occur. 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. A number to uniquely identify care team entries. Member of the team who provided the product or service. The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. The specialization of the practitioner or provider which is applicable for this service. 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. A number to uniquely identify supporting information entries. The general class of the information supplied: information; exception; accident, employment; onset, etc. A finer classification within the more general category. System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. The date when or period to which this information refers. Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. Provides the reason in the situation where a reason code is required in addition to the content. 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. A number to uniquely identify diagnosis entries. The nature of illness or problem in a coded form or as a reference to an external defined Condition. When the condition was observed or the relative ranking. Indication of whether the diagnosis was present on admission to a facility. 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. A number to uniquely identify procedure entries. When the condition was observed or the relative ranking. Date and optionally time the procedure was performed. The code or reference to a Procedure resource which identifies the clinical intervention performed. Unique Device Identifiers associated with this line item. 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. A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order. A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. The business identifier to be used when the claim is sent for adjudication against this insurance policy. 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. A business agreement number established between the provider and the insurer for special business processing purposes. 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. The result of the adjudication of the line items for the Coverage specified in this insurance. 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. Date of an accident event related to the products and services contained in the claim. The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. The physical location of the accident event. 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. A number to uniquely identify item entries. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought. CareTeam members related to this service or product. Diagnosis applicable for this service or product. Procedures applicable for this service or product. Exceptions, special conditions and supporting information applicable for this service or product. The type of revenue or cost center providing the product and/or service. Code to identify the general type of benefits under which products and services are provided. When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims. Request or Referral for Goods or Service to be rendered. Item typification or modifiers codes to convey additional context for the product or service. Identifies the program under which this may be recovered. The date or dates when the service or product was supplied, performed or completed. Where the product or service was provided. The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services. The number of repetitions of a service or product. 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. 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. The total of taxes applicable for this product or service. The total amount claimed for the group (if a grouper) or the line item. Net = unit price * quantity * factor. Unique Device Identifiers associated with this line item. Physical location where the service is performed or applies. Healthcare encounters related to this claim. A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. 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. Physical service site on the patient (limb, tooth, etc.). A region or surface of the bodySite, e.g. limb region or tooth surface(s). 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. A number to uniquely identify item entries. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. The type of revenue or cost center providing the product and/or service. Code to identify the general type of benefits under which products and services are provided. When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims. Item typification or modifiers codes to convey additional context for the product or service. Identifies the program under which this may be recovered. The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services. The number of repetitions of a service or product. 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. 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. The total of taxes applicable for this product or service. The total amount claimed for the group (if a grouper) or the line item.detail. Net = unit price * quantity * factor. Unique Device Identifiers associated with this line item. A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. 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. A number to uniquely identify item entries. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. The type of revenue or cost center providing the product and/or service. Code to identify the general type of benefits under which products and services are provided. When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims. Item typification or modifiers codes to convey additional context for the product or service. Identifies the program under which this may be recovered. The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services. The number of repetitions of a service or product. 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. 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. The total of taxes applicable for this product or service. The total amount claimed for line item.detail.subDetail. Net = unit price * quantity * factor. Unique Device Identifiers associated with this line item. Claim Preauthorization Predetermination If the element is present, it must have either a @value, an @id, or extensions Active Cancelled Draft Entered in Error If the element is present, it must have either a @value, an @id, or extensions