2026 US Quality Core Implementation Guide
0.5.0 - cibuild US

2026 US Quality Core Implementation Guide, published by Office of the National Coordinator for Health Information Technology (ONC). This guide is not an authorized publication; it is the continuous build for version 0.5.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/FHIR/us-quality-core/ and changes regularly. See the Directory of published versions

## : Claim example - JSON Representation

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    {
      "resourceType" : "Claim",
      "id" : "example",
      "meta" : {
        "profile" : [
          🔗 "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-claim"
        ]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim example</b></p><a name=\"example\"> </a><a name=\"hcexample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-us-quality-core-claim.html\">US Quality Core Claim</a></p></div><p><b>identifier</b>: <code>http://example.org/claims</code>/6612346</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-example.html\">Jim Chalmers  Male, DoB: 1974-12-25 ( Social Security number\u00a0(use:\u00a0usual,\u00a0period:\u00a02001-05-06 --&gt; (ongoing)))</a></p><p><b>created</b>: 2014-08-16</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization Health Level Seven International</a></p><p><b>provider</b>: <a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td><td><a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>OnAdmission</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm K35.80}\">Unspecified acute appendicitis</span></td><td><span title=\"Codes:{https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Coding Y}\">Y</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-example.html\">Coverage: identifier = Member Number; status = active; type = Other Private Insurance; subscriberId = 12191; dependent = 0; relationship = Self; period = 2011-05-23 --&gt; 2012-05-23; order = 9</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>diagnosisSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 44950}\">Appendectomy</span></p><p><b>serviced</b>: 2013-04-05</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>4000.00</td><td>United States dollar</td></tr></table></blockquote></div>"
      },
      "identifier" : [
        {
          "system" : "http://example.org/claims",
          "value" : "6612346"
        }
      ],
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
            "code" : "professional",
            "display" : "Professional"
          }
        ]
      },
      "use" : "claim",
      "patient" : {
        🔗 "reference" : "Patient/example"
      },
      "created" : "2014-08-16",
      "insurer" : {
        🔗 "reference" : "Organization/example"
      },
      "provider" : {
        🔗 "reference" : "Practitioner/example"
      },
      "priority" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
            "code" : "normal"
          }
        ]
      },
      "payee" : {
        "type" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/payeetype",
              "code" : "provider"
            }
          ]
        },
        "party" : {
          🔗 "reference" : "Practitioner/example"
        }
      },
      "careTeam" : [
        {
          "sequence" : 1,
          "provider" : {
            🔗 "reference" : "Practitioner/example"
          }
        }
      ],
      "diagnosis" : [
        {
          "sequence" : 1,
          "diagnosisCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/sid/icd-10-cm",
                "code" : "K35.80",
                "display" : "Unspecified acute appendicitis"
              }
            ]
          },
          "onAdmission" : {
            "coding" : [
              {
                "system" : "https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Coding",
                "code" : "Y"
              }
            ]
          }
        }
      ],
      "insurance" : [
        {
          "sequence" : 1,
          "focal" : true,
          "coverage" : {
            🔗 "reference" : "Coverage/example"
          }
        }
      ],
      "item" : [
        {
          "sequence" : 1,
          "careTeamSequence" : [
            1
          ],
          "diagnosisSequence" : [
            1
          ],
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://www.ama-assn.org/go/cpt",
                "code" : "44950",
                "display" : "Appendectomy"
              }
            ]
          },
          "servicedDate" : "2013-04-05",
          "unitPrice" : {
            "value" : 4000.00,
            "currency" : "USD"
          }
        }
      ]
    }