## Profile Comparison between http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim vs http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim

Left: | RTPBC Request Using Claim (http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim)
Right: | RTPBC Request Using Claim (http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim)

### Messages

Error | StructureDefinition.version | Values for version differ: '1.0.0' vs '2.0.0-ballot'
Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 International - Pharmacy' vs 'HL7 International / Pharmacy'
Information | Claim.language | Example/preferred bindings differ at Claim.language using binding from RtpbcRequestClaim

### Metadata

Name | Value | Comments
--- | --- | ---
abstract | false |
baseDefinition | http://hl7.org/fhir/StructureDefinition/Claim |
copyright |  |
date | 2020-05-23T00:00:00-05:00 |
description | This profile constrains the Claim resource so that it can serve as the RTPBC Request in the consumer real-time pharmacy benefit check process |
experimental |  |
fhirVersion | 4.0.1 |
jurisdiction |  |
jurisdiction[0] | urn:iso:std:iso:3166#US |
kind | resource |
name | RtpbcRequestClaim |
publisher | HL7 International - Pharmacy | HL7 International / Pharmacy | Values Differ
purpose |  |
status | active |
title | RTPBC Request Using Claim |
type | Claim |
url | http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim |
version | 1.0.0 | 2.0.0-ballot | Values Differ

### Structure

Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments
--- | --- | --- | --- | --- | --- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization |
id | S Σ | 1..1 | string | Unique Claim Resource Identifier | S Σ | 1..1 | id | Unique Claim Resource Identifier |
meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
language |  | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
|  | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
| Example/preferred bindings differ at Claim.language using binding from RtpbcRequestClaim
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements |
contained |  | 0..* | Resource | Contained, inline Resources |  | 0..* | Resource | Contained, inline Resources |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier | S | 1..1 | Identifier | RTPBC request identifier | S | 1..1 | Identifier | RTPBC request identifier |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . |
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
value | S Σ | 1..1 | string | Unique RTPBC request ID Example General: 123456 | S Σ | 1..1 | string | Unique RTPBC request ID Example General: 123456 |
period | Σ | 0..1 | Period | Time period when id is/was valid for use | Σ | 0..1 | Period | Time period when id is/was valid for use |
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
status | ?!S Σ | 1..1 | code | Request status Binding: ?? (required): A code specifying the state of the resource instance. Fixed Value: active | ?!S Σ | 1..1 | code | Request status Binding: ?? (required): A code specifying the state of the resource instance. Fixed Value: active |
type | S Σ | 1..1 | CodeableConcept | Requested Service Type Binding: ?? (extensible): The type or discipline-style of the claim. | S Σ | 1..1 | CodeableConcept | Requested Service Type Binding: ?? (extensible): The type or discipline-style of the claim. |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
coding | S Σ | 1..1 | Coding | Code defined by a terminology system | S Σ | 1..1 | Coding | Code defined by a terminology system |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type |
version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant |
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pharmacy | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pharmacy |
display | S Σ | 1..1 | string | Representation defined by the system Fixed Value: Pharmacy | S Σ | 1..1 | string | Representation defined by the system Fixed Value: Pharmacy |
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user |
text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept |
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. |  | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. |
use | S Σ | 1..1 | code | Processing Mode Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: predetermination | S Σ | 1..1 | code | Processing Mode Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: predetermination |
patient | S Σ | 1..1 | Reference(RTPBC Patient) | Request Patient Information | S Σ | 1..1 | Reference(RTPBC Patient) | Request Patient Information |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
reference | S Σ C | 1..1 | string | Patient Reference | S Σ C | 1..1 | string | Patient Reference |
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). |
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource |
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim | Σ | 0..1 | Period | Relevant time frame for the claim |
created | S Σ | 1..1 | dateTime | Created DateTime | S Σ | 1..1 | dateTime | Created DateTime |
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim |
insurer | Σ | 0..1 | Reference(Organization) | Target | Σ | 0..1 | Reference(Organization) | Target |
provider | S Σ | 1..1 | Reference(RTPBC Pharmacy Organization) | Preferred Pharmacy | S Σ | 1..1 | Reference(RTPBC Pharmacy Organization) | Preferred Pharmacy |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
reference | S Σ C | 1..1 | string | Reference to Pharmacy Organization | S Σ C | 1..1 | string | Reference to Pharmacy Organization |
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). |
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource |
priority | S Σ | 1..1 | CodeableConcept | Processing priority Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred. | S Σ | 1..1 | CodeableConcept | Processing priority Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred. |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
coding | S Σ | 1..1 | Coding | Code defined by a terminology system | S Σ | 1..1 | Coding | Code defined by a terminology system |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
system | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | S Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority |
version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant |
code | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal | S Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal |
display | S Σ | 1..1 | string | Representation defined by the system Fixed Value: Normal | S Σ | 1..1 | string | Representation defined by the system Fixed Value: Normal |
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user |
text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept |
fundsReserve |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). |
related |  | 0..* | BackboneElement | Prior or corollary claims |  | 0..* | BackboneElement | Prior or corollary claims |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
claim |  | 0..1 | Reference(Claim) | Reference to the related claim |  | 0..1 | Reference(Claim) | Reference to the related claim |
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. |
reference |  | 0..1 | Identifier | File or case reference |  | 0..1 | Identifier | File or case reference |
prescription | S | 1..1 | Reference(RTPBC Medication Request) | Prescription Reference | S | 1..1 | Reference(RTPBC Medication Request) | Prescription Reference |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
reference | S Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL | S Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL |
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). |
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource |
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller |
payee |  | 0..1 | BackboneElement | Recipient of benefits payable |  | 0..1 | BackboneElement | Recipient of benefits payable |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
type |  | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. |  | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. |
party |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference |
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral |
facility |  | 0..1 | Reference(Location) | Servicing facility |  | 0..1 | Reference(Location) | Servicing facility |
careTeam | S | 1..1 | BackboneElement | Prescriber | S | 1..1 | BackboneElement | Prescriber |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S | 1..1 | positiveInt | Order of care team Fixed Value: 1 | S | 1..1 | positiveInt | Order of care team Fixed Value: 1 |
provider | S | 1..1 | Reference(US Core Practitioner Profile) | Prescriber | S | 1..1 | Reference(US Core Practitioner Profile) | Prescriber |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
reference | S Σ C | 1..1 | string | Prescriber Reference | S Σ C | 1..1 | string | Prescriber Reference |
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). |
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource |
responsible |  | 0..1 | boolean | Indicator of the lead practitioner |  | 0..1 | boolean | Indicator of the lead practitioner |
role |  | 0..1 | CodeableConcept | Function within the team Binding: ?? (example): The role codes for the care team members. |  | 0..1 | CodeableConcept | Function within the team Binding: ?? (example): The role codes for the care team members. |
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. |
supportingInfo |  | 0..* | BackboneElement | Supporting information |  | 0..* | BackboneElement | Supporting information |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Information instance identifier |  | 1..1 | positiveInt | Information instance identifier |
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (example): The valuset used for additional information category codes. |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (example): The valuset used for additional information category codes. |
code |  | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. |  | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. |
timing[x] |  | 0..1 | date, Period | When it occurred |  | 0..1 | date, Period | When it occurred |
value[x] |  | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided |  | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. |  | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. |
diagnosis |  | 0..* | BackboneElement | Pertinent diagnosis information |  | 0..* | BackboneElement | Pertinent diagnosis information |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier |  | 1..1 | positiveInt | Diagnosis instance identifier |
diagnosis[x] |  | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. |  | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. |
type |  | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. |  | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. |
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. |  | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. |
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. |  | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. |
procedure |  | 0..* | BackboneElement | Clinical procedures performed |  | 0..* | BackboneElement | Clinical procedures performed |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Procedure instance identifier |  | 1..1 | positiveInt | Procedure instance identifier |
type |  | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. |  | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. |
date |  | 0..1 | dateTime | When the procedure was performed |  | 0..1 | dateTime | When the procedure was performed |
procedure[x] |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
insurance | S Σ | 1..1 | BackboneElement | Pharmacy Coverage | S Σ | 1..1 | BackboneElement | Pharmacy Coverage |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S Σ | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 | S Σ | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
focal | S Σ | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true | S Σ | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
identifier |  | 0..1 | Identifier | Pre-assigned Claim number |  | 0..1 | Identifier | Pre-assigned Claim number |
coverage | S Σ | 1..1 | Reference(RTPBC Coverage) | Pharmacy Coverage Reference | S Σ | 1..1 | Reference(RTPBC Coverage) | Pharmacy Coverage Reference |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
reference | S Σ C | 0..1 | string | Pharmacy Coverage Reference | S Σ C | 0..1 | string | Pharmacy Coverage Reference |
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). |
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource |
businessArrangement |  | 0..1 | string | Additional provider contract number |  | 0..1 | string | Additional provider contract number |
preAuthRef |  | 0..* | string | Prior authorization reference number |  | 0..* | string | Prior authorization reference number |
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results |  | 0..1 | Reference(ClaimResponse) | Adjudication results |
accident |  | 0..1 | BackboneElement | Details of the event |  | 0..1 | BackboneElement | Details of the event |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
date |  | 1..1 | date | When the incident occurred |  | 1..1 | date | When the incident occurred |
type |  | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. |  | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. |
location[x] |  | 0..1 | Address, Reference(Location) | Where the event occurred |  | 0..1 | Address, Reference(Location) | Where the event occurred |
item | S | 1..1 | BackboneElement | Max 1 item per request | S | 1..1 | BackboneElement | Max 1 item per request |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S | 1..1 | positiveInt | Item instance identifier Fixed Value: 1 | S | 1..1 | positiveInt | Item instance identifier Fixed Value: 1 |
careTeamSequence | S | 1..1 | positiveInt | Care Team Sequence ID Reference | S | 1..1 | positiveInt | Care Team Sequence ID Reference |
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses |  | 0..* | positiveInt | Applicable diagnoses |
procedureSequence |  | 0..* | positiveInt | Applicable procedures |  | 0..* | positiveInt | Applicable procedures |
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information |  | 0..* | positiveInt | Applicable exception and supporting information |
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |
category |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |
productOrService | S | 1..1 | CodeableConcept | Prescribed Product Binding: ?? (extensible): RTPBC prescribable product codes (NDC11 and RxNorm) | S | 1..1 | CodeableConcept | Prescribed Product Binding: ?? (extensible): RTPBC prescribable product codes (NDC11 and RxNorm) |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
coding | S Σ | 1..* | Coding | Code defined by a terminology system | S Σ | 1..* | Coding | Code defined by a terminology system |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
system | S Σ | 1..1 | uri | Identity of the terminology system | S Σ | 1..1 | uri | Identity of the terminology system |
version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant |
code | S Σ | 1..1 | code | Symbol in syntax defined by the system | S Σ | 1..1 | code | Symbol in syntax defined by the system |
display | S Σ | 1..1 | string | Product Description | S Σ | 1..1 | string | Product Description |
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user |
text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept |
modifier |  | 0..* | CodeableConcept | Product or service billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |  | 0..* | CodeableConcept | Product or service billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
serviced[x] |  | 0..1 | date, Period | Date or dates of service or product delivery |  | 0..1 | date, Period | Date or dates of service or product delivery |
location[x] |  | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. |  | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. |
quantity | S | 1..1 | ?? | Prescribed Quantity | S | 1..1 | ?? | Prescribed Quantity |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
value | S Σ | 1..1 | decimal | Quantity in Billing Units | S Σ | 1..1 | decimal | Quantity in Billing Units |
comparator | ?!Σ | 0..0 |  | < | <= | >= | > - how to understand the value Binding: ?? (required): How the Quantity should be understood and represented. | ?!Σ | 0..0 |  | < | <= | >= | > - how to understand the value Binding: ?? (required): How the Quantity should be understood and represented. |
unit | S Σ | 1..1 | string | Billing unit of measure Binding: ?? (extensible): Billing quantity unit of measure | S Σ | 1..1 | string | Billing unit of measure Binding: ?? (extensible): Billing quantity unit of measure |
system | Σ C | 0..1 | uri | System that defines coded unit form | Σ C | 0..1 | uri | System that defines coded unit form |
code | Σ | 0..1 | code | Coded form of the unit | Σ | 0..1 | code | Coded form of the unit |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. |  | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. |
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. |  | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. |
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item |  | 0..* | Reference(Encounter) | Encounters related to this billed item |
detail |  | 0..* | BackboneElement | Product or service provided |  | 0..* | BackboneElement | Product or service provided |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Item instance identifier |  | 1..1 | positiveInt | Item instance identifier |
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |
category |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. |
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
quantity |  | 0..1 | ?? | Count of products or services |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
subDetail |  | 0..* | BackboneElement | Product or service provided |  | 0..* | BackboneElement | Product or service provided |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Item instance identifier |  | 1..1 | positiveInt | Item instance identifier |
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |
category |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. |
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
quantity |  | 0..1 | ?? | Count of products or services |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
total |  | 0..1 | Money | Total claim cost |  | 0..1 | Money | Total claim cost |
Documentation for this format