Patient Cost Transparency Implementation Guide
2.0.0-draft - STU 2 - Draft United States of America flag

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0-draft built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

Resource Profile: PCTGFEProfessional - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 2

Definitions for the davinci-pct-gfe-professional resource profile.

Guidance on how to interpret the contents of this table can be foundhere

0. Claim
Definition

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.

ShortClaim, Pre-determination or Pre-authorization
Comments

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.

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Claim.implicitRules
Definition

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.

ShortA set of rules under which this content was created
Comments

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.

Control0..1
Typeuri
Is Modifiertrue because 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Claim.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. 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.

ShortExtensionAdditional content defined by implementations
Comments

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.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. Claim.extension:gfeServiceLinkingInfo
    Slice NamegfeServiceLinkingInfo
    Definition

    This extension is used to provide the GFE Service Linking Information. This allows implementers to have the same identifier on multiple GFEs that are part of one period of care's services. This would be needed for some of the workflow options that businesses may decide to use.

    ShortGFE Service Linking Information
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(GFEServiceLinkingInfo) (Complex Extension)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. Claim.extension:providerEventMethodology
    Slice NameproviderEventMethodology
    Definition

    How the provider determined the number of claims and the number and type of billing providers to include in the GFE. Examples include provider episodes of care experience, PACES, order set based on clinical guidelines, payor suggested grouping, or some other method of determination. The extension definition contains additional detail.

    ShortProvider event collection methodology
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(ProviderEventMethodology) (Extension Type: string)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. Claim.extension:gfeDisclaimer
    Slice NamegfeDisclaimer
    Definition

    Disclaimers the patient should be made aware of regarding the providers estimate including any additional assumptions and requirements. Noting that that the information provided is only an estimate based on the items and services reasonably expected, at the time of scheduling (or requesting) the item or service, to be furnished and is subject to change.

    ShortDisclaimers the patient should be made aware of regarding the providers estimate
    Comments

    These disclaimers may include, but are not limited to things such as: provider discounts, limitations, preconditions, requirements, assumptions (e.g. diagnostic vs. preventative), information known to be missing in the estimate, conditions that may affect the estimate, or anything that may affect the interpretation of the estimate.

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(GFEDisclaimer) (Extension Type: string)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. Claim.modifierExtension
    Definition

    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).

    ShortExtensions that cannot be ignored
    Comments

    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.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    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.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    14. Claim.identifier
    Definition

    A unique identifier assigned to this claim.

    ShortBusiness Identifier for claim
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..*
    TypeIdentifier
    Is Modifierfalse
    Summaryfalse
    Requirements

    Allows claims to be distinguished and referenced.

    Alternate NamesClaim Number
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Claim.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ type
    • 16. Claim.identifier:PLAC
      Slice NamePLAC
      Definition

      A unique identifier assigned to this claim.

      ShortProvider Assigned Identifier for GFE ClaimBusiness Identifier for claim
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control10..1*
      TypeIdentifier
      Is Modifierfalse
      Summaryfalse
      Requirements

      Allows claims to be distinguished and referenced.

      Alternate NamesClaim Number
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. Claim.identifier:PLAC.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Claim.identifier:PLAC.type
      Definition

      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

      ShortDescription of identifier
      Comments

      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

      Control10..1
      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
      (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows users to make use of identifiers when the identifier system is not known.

      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
          "code" : "PLAC",
          "display" : "Placer Identifier"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Claim.identifier:PLAC.system
      Definition

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control0..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. Claim.identifier:PLAC.value
      Definition

      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control10..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Example<br/><b>General</b>:123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. Claim.identifier:INTER
      Slice NameINTER
      Definition

      A unique identifier assigned to this claim.

      ShortIntermediary System IdentifierBusiness Identifier for claim
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Summaryfalse
      Requirements

      Allows claims to be distinguished and referenced.

      Alternate NamesClaim Number
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Claim.identifier:INTER.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Claim.identifier:INTER.type
      Definition

      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

      ShortDescription of identifier
      Comments

      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

      Control10..1
      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
      (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows users to make use of identifiers when the identifier system is not known.

      Pattern Value{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType",
          "code" : "INTER",
          "display" : "Intermediary System Identifier"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. Claim.status
      Definition

      The status of the resource instance.

      Shortactive | cancelled | draft | entered-in-error
      Comments

      This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

      Control1..1
      BindingThe codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1
      (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

      A code specifying the state of the resource instance.

      Typecode
      Is Modifiertrue because 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
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      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'.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. Claim.type
      Definition

      The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

      ShortCategory or discipline
      Comments

      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.

      Control1..1
      BindingUnless not suitable, these codes SHALL be taken from ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type
      (extensible to http://hl7.org/fhir/ValueSet/claim-type)

      The type or discipline-style of the claim.

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

      Claim type determine the general sets of business rules applied for information requirements and adjudication.

      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
          "code" : "professional"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. Claim.use
      Definition

      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.

      Shortclaim | preauthorization | predetermination
      Control1..1
      BindingThe codes SHALL be taken from Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

      The purpose of the Claim: predetermination, preauthorization, claim.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      This element is required to understand the nature of the request for adjudication.

      Pattern Valuepredetermination
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. Claim.patient
      Definition

      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.

      ShortThe recipient of the products and services
      Control1..1
      TypeReference(HRex Patient Demographics, Patient)
      Is Modifierfalse
      Summarytrue
      Requirements

      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.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. Claim.created
      Definition

      The date this resource was created.

      ShortResource creation date
      Comments

      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.

      Control1..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Need to record a timestamp for use by both the recipient and the issuer.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. Claim.insurer
      Definition

      The Insurer who is target of the request.

      Shorticon Changed:Required if insured estimateTarget
      Control0..1
      TypeReference(PCT Organization, Organization)
      Is Modifierfalse
      Must Supporticon Added:true
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. Claim.provider
      Definition

      The provider which is responsible for the claim, predetermination or preauthorization.

      ShortBilling provider - party responsible for the GFEParty responsible for the claim
      Comments

      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.

      Control1..1
      TypeReference(PCT Organization, PCT Practitioner, Practitioner, PractitionerRole, Organization)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. Claim.provider.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional content defined by implementations
      Comments

      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.

      Control10..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Claim.provider.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 48. Claim.provider.extension:providerTaxonomy
        Slice NameproviderTaxonomy
        Definition

        This extension is used to indicate the taxonomy code of the provider.

        ShortProvider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
        Control1..1
        TypeExtension(ProviderTaxonomy) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        50. Claim.provider.extension:consentForBalanceBilling
        Slice NameconsentForBalanceBilling
        Definition

        If the provider has received a written consent form indicating a patient has agreed to waive their protections and pay up to the full cost for the out-of-network item or service, this will be “true”. If the provider has not received written consent, this will be “false”. This is an attestation only. The billing provider is legally required to maintain the written notice and consent form.

        ShortExtension
        Control0..1
        TypeExtension(GFEConsentForBalanceBilling) (Extension Type: boolean)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        52. Claim.priority
        Definition

        The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

        ShortDesired processing ugency
        Comments

        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.

        Control1..1
        BindingThe codes SHALL be taken from For example codes, see ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority
        (required to http://hl7.org/fhir/ValueSet/process-priority)
        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Requirements

        The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. Claim.payee
        Definition

        The party to be reimbursed for cost of the products and services according to the terms of the policy.

        ShortRecipient of benefits payable
        Comments

        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.

        Control0..1
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. Claim.payee.modifierExtension
        Definition

        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).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        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.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        58. Claim.payee.type
        Definition

        Type of Party to be reimbursed: subscriber, provider, other.

        ShortCategory of recipient
        Control1..1
        BindingFor example codes, see Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype
        (example to http://hl7.org/fhir/ValueSet/payeetype)

        A code for the party to be reimbursed.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. Claim.payee.party
        Definition

        Reference to the individual or organization to whom any payment will be made.

        ShortRecipient reference
        Comments

        Not required if the payee is 'subscriber' or 'provider'.

        Control0..1
        TypeReference(PCT Practitioner, PCT Organization, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson)
        Is Modifierfalse
        Summaryfalse
        Requirements

        Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. Claim.careTeam
        Definition

        The members of the team who provided the products and services.

        ShortMembers of the care team
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Common to identify the responsible and supporting practitioners.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Claim.careTeam. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ role
        • 64. Claim.careTeam.modifierExtension
          Definition

          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).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          66. Claim.careTeam.sequence
          Definition

          A number to uniquely identify care team entries.

          ShortOrder of care team
          Control1..1
          TypepositiveInt
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Requirements

          Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          68. Claim.careTeam.provider
          Definition

          Member of the team who provided the product or service.

          ShortPractitioner or organization
          Control1..1
          TypeReference(PCT Practitioner, PCT Organization, Practitioner, PractitionerRole, Organization)
          Is Modifierfalse
          Summaryfalse
          Requirements

          Often a regulatory requirement to specify the responsible provider.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          70. Claim.careTeam.role
          Definition

          The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

          ShortFunction within the team
          Comments

          Role might not be required when there is only a single provider listed.

          Control10..1
          BindingThe codes SHALL be taken from For example codes, see PCT Care Team Role Value Sethttp://hl7.org/fhir/ValueSet/claim-careteamrole
          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS)
          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Requirements

          When multiple parties are present it is required to distinguish the roles performed by each member.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          72. Claim.careTeam.qualification
          Definition

          The qualification of the practitioner which is applicable for this service.

          ShortPractitioner credential or specialization
          Control0..1
          BindingThe codes SHALL be taken from For example codes, see US Core Provider Role (NUCC)http://hl7.org/fhir/ValueSet/provider-qualification
          (required to http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role)
          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Requirements

          Need to specify which qualification a provider is delivering the product or service under.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          74. Claim.careTeam:rendering
          Slice Namerendering
          Definition

          The members of the team who provided the products and services.

          ShortMembers of the care team
          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Summaryfalse
          Requirements

          Common to identify the responsible and supporting practitioners.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          76. Claim.careTeam:rendering.modifierExtension
          Definition

          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).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          78. Claim.careTeam:rendering.sequence
          Definition

          A number to uniquely identify care team entries.

          ShortOrder of care team
          Control1..1
          TypepositiveInt
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Requirements

          Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          80. Claim.careTeam:rendering.provider
          Definition

          Member of the team who provided the product or service.

          ShortPractitioner or organization
          Control1..1
          TypeReference(PCT Practitioner, PCT Organization, Practitioner, PractitionerRole, Organization)
          Is Modifierfalse
          Summaryfalse
          Requirements

          Often a regulatory requirement to specify the responsible provider.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          82. Claim.careTeam:rendering.role
          Definition

          The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

          ShortFunction within the team
          Comments

          Role might not be required when there is only a single provider listed.

          Control10..1
          BindingThe codes SHALL be taken from For example codes, see PCT Care Team Role Value Sethttp://hl7.org/fhir/ValueSet/claim-careteamrole
          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS)
          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Requirements

          When multiple parties are present it is required to distinguish the roles performed by each member.

          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
              "code" : "rendering"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          84. Claim.careTeam:rendering.qualification
          Definition

          The qualification of the practitioner which is applicable for this service.

          ShortPractitioner credential or specialization - must provide a taxonomy code for the Professional case
          Control10..1
          BindingThe codes SHALL be taken from For example codes, see US Core Provider Role (NUCC)http://hl7.org/fhir/ValueSet/provider-qualification
          (required to http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role)
          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Requirements

          Need to specify which qualification a provider is delivering the product or service under.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          86. Claim.careTeam:referring
          Slice Namereferring
          Definition

          The members of the team who provided the products and services.

          ShortMembers of the care team
          Control0..1*
          TypeBackboneElement
          Is Modifierfalse
          Summaryfalse
          Requirements

          Common to identify the responsible and supporting practitioners.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          88. Claim.careTeam:referring.modifierExtension
          Definition

          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).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          90. Claim.careTeam:referring.sequence
          Definition

          A number to uniquely identify care team entries.

          ShortOrder of care team
          Control1..1
          TypepositiveInt
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Requirements

          Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          92. Claim.careTeam:referring.provider
          Definition

          Member of the team who provided the product or service.

          ShortPractitioner or organization
          Control1..1
          TypeReference(PCT Practitioner, PCT Organization, Practitioner, PractitionerRole, Organization)
          Is Modifierfalse
          Summaryfalse
          Requirements

          Often a regulatory requirement to specify the responsible provider.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          94. Claim.careTeam:referring.role
          Definition

          The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

          ShortFunction within the team
          Comments

          Role might not be required when there is only a single provider listed.

          Control10..1
          BindingThe codes SHALL be taken from For example codes, see PCT Care Team Role Value Sethttp://hl7.org/fhir/ValueSet/claim-careteamrole
          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS)
          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Requirements

          When multiple parties are present it is required to distinguish the roles performed by each member.

          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
              "code" : "referring"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          96. Claim.supportingInfo
          Definition

          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

          ShortSupporting information
          Comments

          Often there are multiple jurisdiction specific valuesets which are required.

          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Requirements

          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

          Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Claim.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ category
          • 98. Claim.supportingInfo.modifierExtension
            Definition

            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).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            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.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            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.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            100. Claim.supportingInfo.sequence
            Definition

            A number to uniquely identify supporting information entries.

            ShortInformation instance identifier
            Control1..1
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Requirements

            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            102. Claim.supportingInfo.category
            Definition

            The general class of the information supplied: information; exception; accident, employment; onset, etc.

            ShortClassification of the supplied information
            Comments

            This may contain a category for the local bill type codes.

            Control1..1
            BindingUnless not suitable, these codes SHALL be taken from For example codes, see PCT Supporting Info Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
            (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS)
            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Requirements

            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            104. Claim.supportingInfo:serviceFacility
            Slice NameserviceFacility
            Definition

            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

            ShortService FacilitySupporting information
            Comments

            Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider.


            Often there are multiple jurisdiction specific valuesets which are required.

            Control0..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

            Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            106. Claim.supportingInfo:serviceFacility.modifierExtension
            Definition

            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).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            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.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            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.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            108. Claim.supportingInfo:serviceFacility.sequence
            Definition

            A number to uniquely identify supporting information entries.

            ShortInformation instance identifier
            Control1..1
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Requirements

            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            110. Claim.supportingInfo:serviceFacility.category
            Definition

            The general class of the information supplied: information; exception; accident, employment; onset, etc.

            ShortClassification of the supplied information
            Comments

            This may contain a category for the local bill type codes.

            Control1..1
            BindingUnless not suitable, these codes SHALL be taken from For example codes, see PCT Supporting Info Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
            (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS)
            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Requirements

            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

            Pattern Value{
              "coding" : [{
                "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
                "code" : "servicefacility"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            112. Claim.supportingInfo:serviceFacility.value[x]
            Definition

            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

            ShortData to be provided
            Comments

            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.

            Control10..1
            TypeReference(Resource), boolean, string, Quantity, Attachment
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Summaryfalse
            Requirements

            To convey the data content to be provided when the information is more than a simple code or period.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Claim.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
            • type @ $this
            • 114. Claim.supportingInfo:serviceFacility.value[x]:valueReference
              Slice NamevalueReference
              Definition

              Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

              ShortData to be provided
              Comments

              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.

              Control10..1
              TypeReference(PCT Organization, Resource), boolean, string, Quantity, Attachment
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Summaryfalse
              Requirements

              To convey the data content to be provided when the information is more than a simple code or period.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              116. Claim.supportingInfo:claimFrequency
              Slice NameclaimFrequency
              Definition

              Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

              ShortClaim FrequencySupporting information
              Comments

              Claim frequency - uses the last digit of the NUBC type of billing code.


              Often there are multiple jurisdiction specific valuesets which are required.

              Control0..1*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

              Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              118. Claim.supportingInfo:claimFrequency.modifierExtension
              Definition

              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).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              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.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              120. Claim.supportingInfo:claimFrequency.sequence
              Definition

              A number to uniquely identify supporting information entries.

              ShortInformation instance identifier
              Control1..1
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

              Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              122. Claim.supportingInfo:claimFrequency.category
              Definition

              The general class of the information supplied: information; exception; accident, employment; onset, etc.

              ShortClassification of the supplied information
              Comments

              This may contain a category for the local bill type codes.

              Control1..1
              BindingUnless not suitable, these codes SHALL be taken from For example codes, see PCT Supporting Info Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
              (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS)
              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

              Pattern Value{
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
                  "code" : "claimFrequency"
                }]
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              124. Claim.supportingInfo:claimFrequency.code
              Definition

              System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

              ShortType of information
              Control10..1
              BindingThe codes SHALL be taken from For example codes, see PCT GFE Frequency Code Value Sethttp://hl7.org/fhir/ValueSet/claim-exception
              (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEFrequencyVS)
              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to identify the kind of additional information.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              126. Claim.diagnosis
              Definition

              Information about diagnoses relevant to the claim items.

              ShortPertinent diagnosis information
              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Required for the adjudication by provided context for the services and product listed.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Claim.diagnosis. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ type
              • 128. Claim.diagnosis.modifierExtension
                Definition

                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).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                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.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                130. Claim.diagnosis.sequence
                Definition

                A number to uniquely identify diagnosis entries.

                ShortDiagnosis instance identifier
                Comments

                Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                Control1..1
                TypepositiveInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Requirements

                Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                132. Claim.diagnosis.diagnosis[x]
                Definition

                The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                ShortNature of illness or problem
                Control1..1
                BindingFor example codes, see ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10
                (example to http://hl7.org/fhir/ValueSet/icd-10)

                Example ICD10 Diagnostic codes.

                TypeChoice of: CodeableConcept, Reference(Condition)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Summaryfalse
                Requirements

                Provides health context for the evaluation of the products and/or services.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                134. Claim.diagnosis.type
                Definition

                When the condition was observed or the relative ranking.

                ShortTiming or nature of the diagnosis
                Comments

                For example: admitting, primary, secondary, discharge.

                Control0..*
                BindingThe codes SHALL be taken from For example codes, see PCT Diagnosis Type Value Sethttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Often required to capture a particular diagnosis, for example: primary or discharge.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                136. Claim.diagnosis:principal
                Slice Nameprincipal
                Definition

                Information about diagnoses relevant to the claim items.

                ShortPrincipal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.Pertinent diagnosis information
                Comments

                If the Principal Diagnosis code is known, it is important that it be shared in the GFE, particularly when the GFE is being sent to a payer for an insured patient. Payers very often need the diagnosis to be able to provide an estimate. Without the diagnosis, payers may assume the service is diagnostic and thus the patient responsibility may be higher or not covered at all than the diagnosis, such as for preventative services, would otherwise indicate. It is understood that in certain situations, such as scheduled services or GFE requests prior to orders, diagnosis is not needed or may not yet be known. However, when it is known, it is important that this information be shared to ensure the best possible estimate is provided to the patient.

                Control0..1*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Required for the adjudication by provided context for the services and product listed.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                138. Claim.diagnosis:principal.modifierExtension
                Definition

                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).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                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.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                140. Claim.diagnosis:principal.sequence
                Definition

                A number to uniquely identify diagnosis entries.

                ShortDiagnosis instance identifier
                Comments

                Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                Control1..1
                TypepositiveInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Requirements

                Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                Pattern Value1
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                142. Claim.diagnosis:principal.diagnosis[x]
                Definition

                The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                ShortNature of illness or problem
                Control1..1
                BindingThe codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10
                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes)
                TypeCodeableConcept, Reference(Condition)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Summaryfalse
                Requirements

                Provides health context for the evaluation of the products and/or services.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                144. Claim.diagnosis:principal.type
                Definition

                When the condition was observed or the relative ranking.

                ShortTiming or nature of the diagnosis
                Comments

                For example: admitting, primary, secondary, discharge.

                Control10..1*
                BindingThe codes SHALL be taken from For example codes, see PCT Diagnosis Type Value Sethttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Often required to capture a particular diagnosis, for example: primary or discharge.

                Pattern Value{
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                    "code" : "principal"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                146. Claim.diagnosis:other
                Slice Nameother
                Definition

                Information about diagnoses relevant to the claim items.

                ShortPertinent diagnosis information
                Control0..11*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Required for the adjudication by provided context for the services and product listed.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                148. Claim.diagnosis:other.modifierExtension
                Definition

                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).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                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.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                150. Claim.diagnosis:other.sequence
                Definition

                A number to uniquely identify diagnosis entries.

                ShortDiagnosis instance identifier
                Comments

                Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                Control1..1
                TypepositiveInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Requirements

                Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                152. Claim.diagnosis:other.diagnosis[x]
                Definition

                The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                ShortNature of illness or problem
                Control1..1
                BindingThe codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10
                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes)
                TypeCodeableConcept, Reference(Condition)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Summaryfalse
                Requirements

                Provides health context for the evaluation of the products and/or services.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                154. Claim.diagnosis:other.type
                Definition

                When the condition was observed or the relative ranking.

                ShortTiming or nature of the diagnosis
                Comments

                For example: admitting, primary, secondary, discharge.

                Control10..1*
                BindingThe codes SHALL be taken from For example codes, see PCT Diagnosis Type Value Sethttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Often required to capture a particular diagnosis, for example: primary or discharge.

                Pattern Value{
                  "coding" : [{
                    "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
                    "code" : "other"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                156. Claim.procedure
                Definition

                Procedures performed on the patient relevant to the billing items with the claim.

                ShortClinical procedures performed
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Claim.procedure. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ type
                • 158. Claim.procedure.extension
                  Definition

                  An Extension


                  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.

                  ShortExtensionAdditional content defined by implementations
                  Comments

                  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.

                  Control10..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 160. Claim.procedure.extension:serviceDescription
                    Slice NameserviceDescription
                    Definition

                    This extension is used to communicate a plain language description of the procedure, product, or service.

                    ShortService Description
                    Control1..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Service Description) (Extension Type: string)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    162. Claim.procedure.modifierExtension
                    Definition

                    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).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    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.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    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.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    164. Claim.procedure.sequence
                    Definition

                    A number to uniquely identify procedure entries.

                    ShortProcedure instance identifier
                    Control1..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Necessary to provide a mechanism to link to claim details.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    166. Claim.procedure.type
                    Definition

                    When the condition was observed or the relative ranking.

                    ShortCategory of Procedure
                    Comments

                    For example: primary, secondary.

                    Control0..*
                    BindingThe codes SHALL be taken from For example codes, see PCT Procedure Type Value Sethttp://hl7.org/fhir/ValueSet/ex-procedure-type
                    (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS)
                    TypeCodeableConcept
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    Often required to capture a particular diagnosis, for example: primary or discharge.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    168. Claim.procedure.procedure[x]
                    Definition

                    The code or reference to a Procedure resource which identifies the clinical intervention performed.

                    ShortSpecific clinical procedure
                    Control1..1
                    BindingFor example codes, see ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures
                    (example to http://hl7.org/fhir/ValueSet/icd-10-procedures)

                    Example ICD10 Procedure codes.

                    TypeChoice of: CodeableConcept, Reference(Procedure)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    This identifies the actual clinical procedure.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    170. Claim.procedure:anesthesiaRelated
                    Slice NameanesthesiaRelated
                    Definition

                    Procedures performed on the patient relevant to the billing items with the claim.

                    ShortClinical procedures performed
                    Control0..2*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    172. Claim.procedure:anesthesiaRelated.extension
                    Definition

                    An Extension


                    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.

                    ShortExtensionAdditional content defined by implementations
                    Comments

                    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.

                    Control10..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 174. Claim.procedure:anesthesiaRelated.extension:serviceDescription
                      Slice NameserviceDescription
                      Definition

                      This extension is used to communicate a plain language description of the procedure, product, or service.

                      ShortService Description
                      Control1..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Service Description) (Extension Type: string)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      176. Claim.procedure:anesthesiaRelated.modifierExtension
                      Definition

                      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).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      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.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      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.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      178. Claim.procedure:anesthesiaRelated.sequence
                      Definition

                      A number to uniquely identify procedure entries.

                      ShortProcedure instance identifier
                      Control1..1
                      TypepositiveInt
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      Necessary to provide a mechanism to link to claim details.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      180. Claim.procedure:anesthesiaRelated.type
                      Definition

                      When the condition was observed or the relative ranking.

                      ShortCategory of Procedure
                      Comments

                      For example: primary, secondary.

                      Control10..1*
                      BindingThe codes SHALL be taken from For example codes, see PCT Procedure Type Value Sethttp://hl7.org/fhir/ValueSet/ex-procedure-type
                      (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS)
                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      Often required to capture a particular diagnosis, for example: primary or discharge.

                      Pattern Value{
                        "coding" : [{
                          "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                          "code" : "procedureRequiringAnesthesia"
                        }]
                      }
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      182. Claim.procedure:anesthesiaRelated.procedure[x]
                      Definition

                      The code or reference to a Procedure resource which identifies the clinical intervention performed.

                      ShortSpecific clinical procedure
                      Control1..1
                      BindingThe codes SHALL be taken from For example codes, see PCT CMS HCPCS and AMA CPT Procedure Surgical Codeshttp://hl7.org/fhir/ValueSet/icd-10-procedures
                      (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes)
                      TypeCodeableConcept, Reference(Procedure)
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      This identifies the actual clinical procedure.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      184. Claim.procedure:other
                      Slice Nameother
                      Definition

                      Procedures performed on the patient relevant to the billing items with the claim.

                      ShortClinical procedures performed
                      Control0..24*
                      TypeBackboneElement
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      186. Claim.procedure:other.extension
                      Definition

                      An Extension


                      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.

                      ShortExtensionAdditional content defined by implementations
                      Comments

                      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.

                      Control10..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 188. Claim.procedure:other.extension:serviceDescription
                        Slice NameserviceDescription
                        Definition

                        This extension is used to communicate a plain language description of the procedure, product, or service.

                        ShortService Description
                        Control1..1
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Service Description) (Extension Type: string)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        190. Claim.procedure:other.modifierExtension
                        Definition

                        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).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        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.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        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.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        192. Claim.procedure:other.sequence
                        Definition

                        A number to uniquely identify procedure entries.

                        ShortProcedure instance identifier
                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Necessary to provide a mechanism to link to claim details.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        194. Claim.procedure:other.type
                        Definition

                        When the condition was observed or the relative ranking.

                        ShortCategory of Procedure
                        Comments

                        For example: primary, secondary.

                        Control10..1*
                        BindingThe codes SHALL be taken from For example codes, see PCT Procedure Type Value Sethttp://hl7.org/fhir/ValueSet/ex-procedure-type
                        (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Often required to capture a particular diagnosis, for example: primary or discharge.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                            "code" : "other"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        196. Claim.procedure:other.procedure[x]
                        Definition

                        The code or reference to a Procedure resource which identifies the clinical intervention performed.

                        ShortSpecific clinical procedure
                        Control1..1
                        BindingThe codes SHALL be taken from For example codes, see PCT CMS HCPCS and AMA CPT Procedure Surgical Codeshttp://hl7.org/fhir/ValueSet/icd-10-procedures
                        (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes)
                        TypeCodeableConcept, Reference(Procedure)
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        This identifies the actual clinical procedure.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        198. Claim.insurance
                        Definition

                        Financial instruments for reimbursement for the health care products and services specified on the claim.

                        ShortPatient insurance information
                        Comments

                        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.

                        Control1..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        At least one insurer is required for a claim to be a claim.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        200. Claim.insurance.modifierExtension
                        Definition

                        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).

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

                        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.

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

                        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.

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        202. Claim.insurance.sequence
                        Definition

                        A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.

                        ShortInsurance instance identifier
                        Control1..1
                        TypepositiveInt
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        To maintain order of the coverages.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        204. Claim.insurance.focal
                        Definition

                        A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

                        ShortCoverage to be used for adjudication
                        Comments

                        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.

                        Control1..1
                        Typeboolean
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        To identify which coverage in the list is being used to adjudicate this claim.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        206. Claim.insurance.coverage
                        Definition

                        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.

                        ShortInsurance information
                        Control1..1
                        TypeReference(PCT Coverage, Coverage)
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Required to allow the adjudicator to locate the correct policy and history within their information system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        208. Claim.insurance.coverage.extension:dataAbsentReason
                        Slice NamedataAbsentReason
                        Definition

                        Provides a reason why the expected value or elements in the element that is extended are missing.

                        ShortCoverage may be not applicable if estimate is for self-pay or uninsured
                        Control0..1
                        TypeExtension(Data Absent Reason) (Extension Type: code)
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        210. Claim.insurance.preAuthRef
                        Definition

                        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.

                        ShortPrior authorization reference number
                        Comments

                        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.

                        Control0..2*
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        212. Claim.item
                        Definition

                        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.

                        ShortProduct or service provided
                        Control10..50*
                        TypeBackboneElement
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        The items to be processed for adjudication.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        214. Claim.item.extension
                        Definition

                        An Extension


                        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.

                        ShortExtensionAdditional content defined by implementations
                        Comments

                        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.

                        Control10..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        SlicingThis element introduces a set of slices on Claim.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 216. Claim.item.extension:referralNumber
                          Slice NamereferralNumber
                          Definition

                          This extension is used to provide the Referral Number.

                          ShortReferral Number
                          Control0..11
                          This element is affected by the following invariants: ele-1
                          TypeExtension(ReferralNumber) (Extension Type: string)
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          218. Claim.item.extension:gfeBillingProviderLineItemCtrlNum
                          Slice NamegfeBillingProviderLineItemCtrlNum
                          Definition

                          This extension is used by the provider to assign a unique identifier to this item. The intent of this element is to allow the provider to assign something other than 'line number' for their purposes (e.g. tracking and troubleshooting).

                          ShortExtension
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(GFEBillingProviderLineItemCtrlNum) (Extension Type: Identifier)
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          220. Claim.item.extension:serviceDescription
                          Slice NameserviceDescription
                          Definition

                          This extension is used to communicate a plain language description of the procedure, product, or service.

                          ShortService Description
                          Control1..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(Service Description) (Extension Type: string)
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          222. Claim.item.extension:ProviderEventMethodology
                          Slice NameProviderEventMethodology
                          Definition

                          This extension is used for indicating the method a provider used to group services, and those providing such services, beyond what may be indicated through DRGs that the payer or patient may find helpful (e.g. grouping services by a standardized episode of care definition). This is provider generated text and should not be modified by the payer.

                          ShortProvider Event Methodology
                          Comments

                          The method a provider used to group services. The extension definition contains additional detail.

                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(ProviderEventMethodology) (Extension Type: string)
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          224. Claim.item.modifierExtension
                          Definition

                          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).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          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.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          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.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          226. Claim.item.sequence
                          Definition

                          A number to uniquely identify item entries.

                          ShortItem instance identifier
                          Control1..1
                          TypepositiveInt
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summaryfalse
                          Requirements

                          Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          228. Claim.item.careTeamSequence
                          Definition

                          CareTeam members related to this service or product.

                          ShortApplicable careTeam members
                          Control0..*
                          TypepositiveInt
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Need to identify the individuals and their roles in the provision of the product or service.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          230. Claim.item.productOrService
                          Definition

                          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.

                          ShortBilling, service, product, or drug code
                          Comments

                          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'.

                          Control1..1
                          BindingThe codes SHALL be taken from For example codes, see Claim Medical Product or Service Value Sethttp://hl7.org/fhir/ValueSet/service-uscls
                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Necessary to state what was provided or done.

                          Alternate NamesDrug Code, Bill Code, Service Code
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          232. Claim.item.productOrService.coding
                          Definition

                          A reference to a code defined by a terminology system.

                          ShortCode defined by a terminology system
                          Comments

                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                          Control0..*
                          TypeCoding
                          Is Modifierfalse
                          Summarytrue
                          Requirements

                          Allows for alternative encodings within a code system, and translations to other code systems.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          pct-cpt-display: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) (system = 'http://www.ama-assn.org/go/cpt' implies display.exists())
                          234. Claim.item.modifier
                          Definition

                          Item typification or modifiers codes to convey additional context for the product or service.

                          ShortProduct or service billing modifiers
                          Comments

                          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.

                          Control0..4*
                          BindingThe codes SHALL be taken from For example codes, see PCT GFE Item CPT - HCPCS Value Sethttp://hl7.org/fhir/ValueSet/claim-modifiers
                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          To support inclusion of the item for adjudication or to charge an elevated fee.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          236. Claim.item.modifier.coding
                          Definition

                          A reference to a code defined by a terminology system.

                          ShortCode defined by a terminology system
                          Comments

                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                          Control0..*
                          TypeCoding
                          Is Modifierfalse
                          Summarytrue
                          Requirements

                          Allows for alternative encodings within a code system, and translations to other code systems.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          pct-cpt-display: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) (system = 'http://www.ama-assn.org/go/cpt' implies display.exists())
                          238. Claim.item.serviced[x]
                          Definition

                          This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication


                          The date or dates when the service or product was supplied, performed or completed.

                          ShortThis is the planned or estimated date(s)s of serviceDate or dates of service or product delivery
                          Control10..1
                          TypeChoice of: date, Period
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          Must Support TypesNo must-support rules about the choice of types/profiles
                          Summaryfalse
                          Requirements

                          Needed to determine whether the service or product was provided during the term of the insurance coverage.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          240. Claim.item.location[x]
                          Definition

                          Where the product or service was provided.

                          ShortPlace of service or where product was supplied
                          Control10..1
                          BindingThe codes SHALL be taken from For example codes, see PCT GFE CMS Place of Service Value Sethttp://hl7.org/fhir/ValueSet/service-place
                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOS)
                          TypeCodeableConcept, Address, Reference(Location)
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          242. Claim.item.quantity
                          Definition

                          The number of repetitions of a service or product.

                          ShortCount of products or services
                          Control10..1
                          TypeQuantity(SimpleQuantity)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Required when the product or service code does not convey the quantity provided.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          244. Claim.item.unitPrice
                          Definition

                          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.

                          ShortFee, charge or cost per item
                          Control10..1
                          TypeMoney
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          The amount charged to the patient by the provider for a single unit.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          246. Claim.item.net
                          Definition

                          The quantity times the unit price for an additional service or product or charge.

                          ShortTotal charge amount for the service lineTotal item cost
                          Comments

                          For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                          Control10..1
                          TypeMoney
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Provides the total amount claimed for the group (if a grouper) or the line item.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          248. Claim.item.detail
                          Definition

                          A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                          ShortDrug Identification InformationProduct or service provided
                          Control0..*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          The items to be processed for adjudication.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          250. Claim.item.detail.modifierExtension
                          Definition

                          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).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          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.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          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.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          252. Claim.item.detail.sequence
                          Definition

                          A number to uniquely identify item entries.

                          ShortItem instance identifier
                          Control1..1
                          TypepositiveInt
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summaryfalse
                          Requirements

                          Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          254. Claim.item.detail.productOrService
                          Definition

                          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.

                          ShortBilling, service, product, or drug code
                          Comments

                          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'.

                          Control1..1
                          BindingThe codes SHALL be taken from For example codes, see Claim Medical Product or Service Value Sethttp://hl7.org/fhir/ValueSet/service-uscls
                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Necessary to state what was provided or done.

                          Alternate NamesDrug Code, Bill Code, Service Code
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          256. Claim.item.detail.quantity
                          Definition

                          The number of repetitions of a service or product.

                          ShortCount of products or services
                          Control0..1
                          TypeQuantity(SimpleQuantity)
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Required when the product or service code does not convey the quantity provided.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          258. Claim.total
                          Definition

                          The total value of the all the items in the claim.

                          ShortTotal GFE Charges SubmittedTotal claim cost
                          Control10..1
                          TypeMoney
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Used for control total purposes.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                          Guidance on how to interpret the contents of this table can be foundhere

                          0. Claim
                          2. Claim.extension
                          SlicingThis element introduces a set of slices on Claim.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 4. Claim.extension:gfeServiceLinkingInfo
                            Slice NamegfeServiceLinkingInfo
                            ShortGFE Service Linking Information
                            Control0..1
                            TypeExtension(GFEServiceLinkingInfo) (Complex Extension)
                            Must Supporttrue
                            6. Claim.extension:providerEventMethodology
                            Slice NameproviderEventMethodology
                            Definition

                            How the provider determined the number of claims and the number and type of billing providers to include in the GFE. Examples include provider episodes of care experience, PACES, order set based on clinical guidelines, payor suggested grouping, or some other method of determination. The extension definition contains additional detail.

                            ShortProvider event collection methodology
                            Control0..1
                            TypeExtension(ProviderEventMethodology) (Extension Type: string)
                            Must Supporttrue
                            8. Claim.extension:gfeDisclaimer
                            Slice NamegfeDisclaimer
                            Definition

                            Disclaimers the patient should be made aware of regarding the providers estimate including any additional assumptions and requirements. Noting that that the information provided is only an estimate based on the items and services reasonably expected, at the time of scheduling (or requesting) the item or service, to be furnished and is subject to change.

                            ShortDisclaimers the patient should be made aware of regarding the providers estimate
                            Comments

                            These disclaimers may include, but are not limited to things such as: provider discounts, limitations, preconditions, requirements, assumptions (e.g. diagnostic vs. preventative), information known to be missing in the estimate, conditions that may affect the estimate, or anything that may affect the interpretation of the estimate.

                            Control0..*
                            TypeExtension(GFEDisclaimer) (Extension Type: string)
                            Must Supporttrue
                            10. Claim.identifier
                            NoteThis is a business identifier, not a resource identifier (see discussion)
                            Control1..?
                            SlicingThis element introduces a set of slices on Claim.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ type
                            • 12. Claim.identifier:PLAC
                              Slice NamePLAC
                              ShortProvider Assigned Identifier for GFE Claim
                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control1..1
                              14. Claim.identifier:PLAC.type
                              Control1..?
                              Pattern Value{
                                "coding" : [{
                                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                  "code" : "PLAC",
                                  "display" : "Placer Identifier"
                                }]
                              }
                              16. Claim.identifier:PLAC.system
                              Must Supporttrue
                              18. Claim.identifier:PLAC.value
                              Control1..?
                              20. Claim.identifier:INTER
                              Slice NameINTER
                              ShortIntermediary System Identifier
                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control0..*
                              22. Claim.identifier:INTER.type
                              Control1..?
                              Pattern Value{
                                "coding" : [{
                                  "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType",
                                  "code" : "INTER",
                                  "display" : "Intermediary System Identifier"
                                }]
                              }
                              24. Claim.type
                              Pattern Value{
                                "coding" : [{
                                  "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
                                  "code" : "professional"
                                }]
                              }
                              26. Claim.use
                              Pattern Valuepredetermination
                              28. Claim.patient
                              TypeReference(HRex Patient Demographics)
                              30. Claim.insurer
                              ShortRequired if insured estimate
                              TypeReference(PCT Organization)
                              Must Supporttrue
                              32. Claim.provider
                              ShortBilling provider - party responsible for the GFE
                              TypeReference(PCT Organization, PCT Practitioner)
                              34. Claim.provider.extension
                              Control1..?
                              36. Claim.provider.extension:providerTaxonomy
                              Slice NameproviderTaxonomy
                              ShortProvider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
                              Control1..1
                              TypeExtension(ProviderTaxonomy) (Extension Type: CodeableConcept)
                              38. Claim.provider.extension:consentForBalanceBilling
                              Slice NameconsentForBalanceBilling
                              Control0..1
                              TypeExtension(GFEConsentForBalanceBilling) (Extension Type: boolean)
                              Must Supporttrue
                              40. Claim.priority
                              BindingThe codes SHALL be taken from ProcessPriorityCodes
                              (required to http://hl7.org/fhir/ValueSet/process-priority)
                              42. Claim.payee
                              Must Supporttrue
                              44. Claim.payee.party
                              TypeReference(PCT Practitioner, PCT Organization)
                              46. Claim.referral
                              48. Claim.referral.extension
                              Control1..?
                              50. Claim.referral.extension:referralNumber
                              Slice NamereferralNumber
                              ShortReferral Number
                              Control1..1
                              TypeExtension(ReferralNumber) (Extension Type: string)
                              52. Claim.careTeam
                              Must Supporttrue
                              SlicingThis element introduces a set of slices on Claim.careTeam. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ role
                              • 54. Claim.careTeam.provider
                                TypeReference(PCT Practitioner, PCT Organization)
                                56. Claim.careTeam.role
                                Control1..?
                                BindingThe codes SHALL be taken from PCT Care Team Role Value Set
                                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS)
                                58. Claim.careTeam.qualification
                                BindingThe codes SHALL be taken from US Core Provider Role (NUCC)
                                (required to http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role)
                                60. Claim.careTeam:rendering
                                Slice Namerendering
                                Control0..*
                                62. Claim.careTeam:rendering.role
                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
                                    "code" : "rendering"
                                  }]
                                }
                                64. Claim.careTeam:rendering.qualification
                                ShortPractitioner credential or specialization - must provide a taxonomy code for the Professional case
                                Control1..?
                                66. Claim.careTeam:referring
                                Slice Namereferring
                                Control0..1
                                68. Claim.careTeam:referring.role
                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
                                    "code" : "referring"
                                  }]
                                }
                                70. Claim.supportingInfo
                                Must Supporttrue
                                SlicingThis element introduces a set of slices on Claim.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ category
                                • 72. Claim.supportingInfo.category
                                  BindingUnless not suitable, these codes SHALL be taken from PCT Supporting Info Type Value Set
                                  (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS)
                                  74. Claim.supportingInfo:serviceFacility
                                  Slice NameserviceFacility
                                  ShortService Facility
                                  Comments

                                  Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider.

                                  Control0..1
                                  Must Supporttrue
                                  76. Claim.supportingInfo:serviceFacility.category
                                  Pattern Value{
                                    "coding" : [{
                                      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
                                      "code" : "servicefacility"
                                    }]
                                  }
                                  78. Claim.supportingInfo:serviceFacility.value[x]
                                  Control1..?
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  SlicingThis element introduces a set of slices on Claim.supportingInfo.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • type @ $this
                                  • 80. Claim.supportingInfo:serviceFacility.value[x]:valueReference
                                    Slice NamevalueReference
                                    Control1..1
                                    TypeReference(PCT Organization)
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    82. Claim.supportingInfo:claimFrequency
                                    Slice NameclaimFrequency
                                    ShortClaim Frequency
                                    Comments

                                    Claim frequency - uses the last digit of the NUBC type of billing code.

                                    Control0..1
                                    Must Supporttrue
                                    84. Claim.supportingInfo:claimFrequency.category
                                    Pattern Value{
                                      "coding" : [{
                                        "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
                                        "code" : "claimFrequency"
                                      }]
                                    }
                                    86. Claim.supportingInfo:claimFrequency.code
                                    Control1..?
                                    BindingThe codes SHALL be taken from PCT GFE Frequency Code Value Set
                                    (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEFrequencyVS)
                                    88. Claim.diagnosis
                                    Must Supporttrue
                                    SlicingThis element introduces a set of slices on Claim.diagnosis. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ type
                                    • 90. Claim.diagnosis.type
                                      BindingThe codes SHALL be taken from PCT Diagnosis Type Value Set
                                      (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS)
                                      Must Supporttrue
                                      92. Claim.diagnosis:principal
                                      Slice Nameprincipal
                                      ShortPrincipal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
                                      Comments

                                      If the Principal Diagnosis code is known, it is important that it be shared in the GFE, particularly when the GFE is being sent to a payer for an insured patient. Payers very often need the diagnosis to be able to provide an estimate. Without the diagnosis, payers may assume the service is diagnostic and thus the patient responsibility may be higher or not covered at all than the diagnosis, such as for preventative services, would otherwise indicate. It is understood that in certain situations, such as scheduled services or GFE requests prior to orders, diagnosis is not needed or may not yet be known. However, when it is known, it is important that this information be shared to ensure the best possible estimate is provided to the patient.

                                      Control0..1
                                      Must Supporttrue
                                      94. Claim.diagnosis:principal.sequence
                                      Pattern Value1
                                      96. Claim.diagnosis:principal.diagnosis[x]
                                      BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
                                      (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes)
                                      TypeCodeableConcept
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      98. Claim.diagnosis:principal.type
                                      Control1..1
                                      Pattern Value{
                                        "coding" : [{
                                          "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                                          "code" : "principal"
                                        }]
                                      }
                                      100. Claim.diagnosis:other
                                      Slice Nameother
                                      Control0..11
                                      Must Supporttrue
                                      102. Claim.diagnosis:other.diagnosis[x]
                                      BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
                                      (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes)
                                      TypeCodeableConcept
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      104. Claim.diagnosis:other.type
                                      Control1..1
                                      Pattern Value{
                                        "coding" : [{
                                          "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
                                          "code" : "other"
                                        }]
                                      }
                                      106. Claim.procedure
                                      Must Supporttrue
                                      SlicingThis element introduces a set of slices on Claim.procedure. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ type
                                      • 108. Claim.procedure.extension
                                        Control1..?
                                        SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 110. Claim.procedure.extension:serviceDescription
                                          Slice NameserviceDescription
                                          Control1..1
                                          TypeExtension(Service Description) (Extension Type: string)
                                          112. Claim.procedure.type
                                          BindingThe codes SHALL be taken from PCT Procedure Type Value Set
                                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS)
                                          Must Supporttrue
                                          114. Claim.procedure:anesthesiaRelated
                                          Slice NameanesthesiaRelated
                                          Control0..2
                                          Must Supporttrue
                                          116. Claim.procedure:anesthesiaRelated.extension:serviceDescription
                                          Slice NameserviceDescription
                                          Control1..1
                                          TypeExtension(Service Description) (Extension Type: string)
                                          118. Claim.procedure:anesthesiaRelated.type
                                          Control1..1
                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                                              "code" : "procedureRequiringAnesthesia"
                                            }]
                                          }
                                          120. Claim.procedure:anesthesiaRelated.procedure[x]
                                          BindingThe codes SHALL be taken from PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
                                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes)
                                          TypeCodeableConcept
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          122. Claim.procedure:other
                                          Slice Nameother
                                          Control0..24
                                          Must Supporttrue
                                          124. Claim.procedure:other.extension:serviceDescription
                                          Slice NameserviceDescription
                                          Control1..1
                                          TypeExtension(Service Description) (Extension Type: string)
                                          126. Claim.procedure:other.type
                                          Control1..1
                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                                              "code" : "other"
                                            }]
                                          }
                                          128. Claim.procedure:other.procedure[x]
                                          BindingThe codes SHALL be taken from PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
                                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes)
                                          TypeCodeableConcept
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          130. Claim.insurance
                                          132. Claim.insurance.coverage
                                          TypeReference(PCT Coverage)
                                          134. Claim.insurance.coverage.extension:dataAbsentReason
                                          Slice NamedataAbsentReason
                                          ShortCoverage may be not applicable if estimate is for self-pay or uninsured
                                          Control0..1
                                          TypeExtension(Data Absent Reason) (Extension Type: code)
                                          Must Supporttrue
                                          136. Claim.insurance.preAuthRef
                                          Control0..2
                                          138. Claim.accident
                                          140. Claim.accident.location[x]
                                          TypeAddress, Reference(Location)
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          142. Claim.accident.location[x].country
                                          BindingThe codes SHALL be taken from Iso3166-1-2
                                          (required to http://hl7.org/fhir/ValueSet/iso3166-1-2)
                                          144. Claim.item
                                          Control1..50
                                          146. Claim.item.extension
                                          Control1..?
                                          SlicingThis element introduces a set of slices on Claim.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 148. Claim.item.extension:referralNumber
                                            Slice NamereferralNumber
                                            ShortReferral Number
                                            Control0..11
                                            TypeExtension(ReferralNumber) (Extension Type: string)
                                            Must Supporttrue
                                            150. Claim.item.extension:gfeBillingProviderLineItemCtrlNum
                                            Slice NamegfeBillingProviderLineItemCtrlNum
                                            Control0..1
                                            TypeExtension(GFEBillingProviderLineItemCtrlNum) (Extension Type: Identifier)
                                            Must Supporttrue
                                            152. Claim.item.extension:serviceDescription
                                            Slice NameserviceDescription
                                            Control1..1
                                            TypeExtension(Service Description) (Extension Type: string)
                                            154. Claim.item.extension:ProviderEventMethodology
                                            Slice NameProviderEventMethodology
                                            ShortProvider Event Methodology
                                            Comments

                                            The method a provider used to group services. The extension definition contains additional detail.

                                            Control0..1
                                            TypeExtension(ProviderEventMethodology) (Extension Type: string)
                                            Must Supporttrue
                                            156. Claim.item.careTeamSequence
                                            Must Supporttrue
                                            158. Claim.item.productOrService
                                            BindingThe codes SHALL be taken from Claim Medical Product or Service Value Set
                                            (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes)
                                            160. Claim.item.productOrService.coding
                                            Invariantspct-cpt-display: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) (system = 'http://www.ama-assn.org/go/cpt' implies display.exists())
                                            162. Claim.item.modifier
                                            Control0..4
                                            BindingThe codes SHALL be taken from PCT GFE Item CPT - HCPCS Value Set
                                            (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS)
                                            Must Supporttrue
                                            164. Claim.item.modifier.coding
                                            Invariantspct-cpt-display: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) (system = 'http://www.ama-assn.org/go/cpt' implies display.exists())
                                            166. Claim.item.serviced[x]
                                            Definition

                                            This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication

                                            ShortThis is the planned or estimated date(s)s of service
                                            Control1..?
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Must Supporttrue
                                            168. Claim.item.location[x]
                                            Control1..?
                                            BindingThe codes SHALL be taken from PCT GFE CMS Place of Service Value Set
                                            (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOS)
                                            TypeCodeableConcept, Address, Reference(Location)
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            170. Claim.item.quantity
                                            Control1..?
                                            172. Claim.item.unitPrice
                                            Control1..?
                                            174. Claim.item.net
                                            ShortTotal charge amount for the service line
                                            Control1..?
                                            176. Claim.item.detail
                                            ShortDrug Identification Information
                                            Must Supporttrue
                                            178. Claim.item.detail.productOrService
                                            BindingThe codes SHALL be taken from Claim Medical Product or Service Value Set
                                            (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes)
                                            180. Claim.item.detail.quantity
                                            Must Supporttrue
                                            182. Claim.total
                                            ShortTotal GFE Charges Submitted
                                            Control1..?

                                            Guidance on how to interpret the contents of this table can be foundhere

                                            0. Claim
                                            Definition

                                            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.

                                            ShortClaim, Pre-determination or Pre-authorization
                                            Comments

                                            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.

                                            Control0..*
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
                                            Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                                            dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                                            dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                                            dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                                            dom-6: A resource should have narrative for robust management (text.`div`.exists())
                                            2. Claim.id
                                            Definition

                                            The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                                            ShortLogical id of this artifact
                                            Comments

                                            The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                                            Control0..1
                                            Typeid
                                            Is Modifierfalse
                                            Summarytrue
                                            4. Claim.meta
                                            Definition

                                            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.

                                            ShortMetadata about the resource
                                            Control0..1
                                            TypeMeta
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            6. Claim.implicitRules
                                            Definition

                                            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.

                                            ShortA set of rules under which this content was created
                                            Comments

                                            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.

                                            Control0..1
                                            Typeuri
                                            Is Modifiertrue because 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
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            8. Claim.language
                                            Definition

                                            The base language in which the resource is written.

                                            ShortLanguage of the resource content
                                            Comments

                                            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).

                                            Control0..1
                                            BindingThe codes SHOULD be taken from CommonLanguages
                                            (preferred to http://hl7.org/fhir/ValueSet/languages)

                                            A human language.

                                            Additional BindingsPurpose
                                            AllLanguagesMax Binding
                                            Typecode
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            10. Claim.text
                                            Definition

                                            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.

                                            ShortText summary of the resource, for human interpretation
                                            Comments

                                            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.

                                            Control0..1
                                            TypeNarrative
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesnarrative, html, xhtml, display
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            12. Claim.contained
                                            Definition

                                            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.

                                            ShortContained, inline Resources
                                            Comments

                                            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.

                                            Control0..*
                                            TypeResource
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesinline resources, anonymous resources, contained resources
                                            14. Claim.extension
                                            Definition

                                            An Extension

                                            ShortExtension
                                            Controlicon Changed:0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            SlicingThis element introduces a set of slices on Claim.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 16. Claim.extension:gfeServiceLinkingInfo
                                              Slice NamegfeServiceLinkingInfo
                                              Definition

                                              This extension is used to provide the GFE Service Linking Information. This allows implementers to have the same identifier on multiple GFEs that are part of one period of care's services. This would be needed for some of the workflow options that businesses may decide to use.

                                              ShortGFE Service Linking Information
                                              Control0..1
                                              This element is affected by the following invariants: ele-1
                                              TypeExtension(GFEServiceLinkingInfo) (Complex Extension)
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              18. Claim.extension:providerEventMethodology
                                              Slice NameproviderEventMethodology
                                              Definition

                                              How the provider determined the number of claims and the number and type of billing providers to include in the GFE. Examples include provider episodes of care experience, PACES, order set based on clinical guidelines, payor suggested grouping, or some other method of determination. The extension definition contains additional detail.

                                              ShortProvider event collection methodology
                                              Control0..1
                                              This element is affected by the following invariants: ele-1
                                              TypeExtension(ProviderEventMethodology) (Extension Type: string)
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              20. Claim.extension:gfeDisclaimer
                                              Slice NamegfeDisclaimer
                                              Definition

                                              Disclaimers the patient should be made aware of regarding the providers estimate including any additional assumptions and requirements. Noting that that the information provided is only an estimate based on the items and services reasonably expected, at the time of scheduling (or requesting) the item or service, to be furnished and is subject to change.

                                              ShortDisclaimers the patient should be made aware of regarding the providers estimate
                                              Comments

                                              These disclaimers may include, but are not limited to things such as: provider discounts, limitations, preconditions, requirements, assumptions (e.g. diagnostic vs. preventative), information known to be missing in the estimate, conditions that may affect the estimate, or anything that may affect the interpretation of the estimate.

                                              Control0..*
                                              This element is affected by the following invariants: ele-1
                                              TypeExtension(GFEDisclaimer) (Extension Type: string)
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              22. Claim.modifierExtension
                                              Definition

                                              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).

                                              ShortExtensions that cannot be ignored
                                              Comments

                                              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.

                                              Control0..*
                                              TypeExtension
                                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                              Summaryfalse
                                              Requirements

                                              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.

                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              24. Claim.identifier
                                              Definition

                                              A unique identifier assigned to this claim.

                                              ShortBusiness Identifier for claim
                                              NoteThis is a business identifier, not a resource identifier (see discussion)
                                              Control1..*
                                              TypeIdentifier
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Allows claims to be distinguished and referenced.

                                              Alternate NamesClaim Number
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              SlicingThis element introduces a set of slices on Claim.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ type
                                              • 26. Claim.identifier:PLAC
                                                Slice NamePLAC
                                                Definition

                                                A unique identifier assigned to this claim.

                                                ShortProvider Assigned Identifier for GFE Claim
                                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                                Control1..1
                                                TypeIdentifier
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Allows claims to be distinguished and referenced.

                                                Alternate NamesClaim Number
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                28. Claim.identifier:PLAC.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                30. Claim.identifier:PLAC.extension
                                                Definition

                                                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.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                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.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                SlicingThis element introduces a set of slices on Claim.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 32. Claim.identifier:PLAC.use
                                                  Definition

                                                  The purpose of this identifier.

                                                  Shortusual | official | temp | secondary | old (If known)
                                                  Comments

                                                  Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                  Control0..1
                                                  BindingThe codes SHALL be taken from IdentifierUse
                                                  (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                                  Identifies the purpose for this identifier, if known .

                                                  Typecode
                                                  Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Requirements

                                                  Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  34. Claim.identifier:PLAC.type
                                                  Definition

                                                  A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                  ShortDescription of identifier
                                                  Comments

                                                  This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                  Control1..1
                                                  BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                  (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                                  A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Requirements

                                                  Allows users to make use of identifiers when the identifier system is not known.

                                                  Pattern Value{
                                                    "coding" : [{
                                                      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                                      "code" : "PLAC",
                                                      "display" : "Placer Identifier"
                                                    }]
                                                  }
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  36. Claim.identifier:PLAC.system
                                                  Definition

                                                  Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                  ShortThe namespace for the identifier value
                                                  Comments

                                                  Identifier.system is always case sensitive.

                                                  Control0..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Requirements

                                                  There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                  Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  38. Claim.identifier:PLAC.value
                                                  Definition

                                                  The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                  ShortThe value that is unique
                                                  Comments

                                                  If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                  Control1..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Example<br/><b>General</b>:123456
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  40. Claim.identifier:PLAC.period
                                                  Definition

                                                  Time period during which identifier is/was valid for use.

                                                  ShortTime period when id is/was valid for use
                                                  Control0..1
                                                  TypePeriod
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  42. Claim.identifier:PLAC.assigner
                                                  Definition

                                                  Organization that issued/manages the identifier.

                                                  ShortOrganization that issued id (may be just text)
                                                  Comments

                                                  The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                  Control0..1
                                                  TypeReference(Organization)
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  44. Claim.identifier:INTER
                                                  Slice NameINTER
                                                  Definition

                                                  A unique identifier assigned to this claim.

                                                  ShortIntermediary System Identifier
                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                  Control0..*
                                                  TypeIdentifier
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Allows claims to be distinguished and referenced.

                                                  Alternate NamesClaim Number
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  46. Claim.identifier:INTER.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  48. Claim.identifier:INTER.extension
                                                  Definition

                                                  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.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  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.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  SlicingThis element introduces a set of slices on Claim.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 50. Claim.identifier:INTER.use
                                                    Definition

                                                    The purpose of this identifier.

                                                    Shortusual | official | temp | secondary | old (If known)
                                                    Comments

                                                    Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                    Control0..1
                                                    BindingThe codes SHALL be taken from IdentifierUse
                                                    (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                                    Identifies the purpose for this identifier, if known .

                                                    Typecode
                                                    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Requirements

                                                    Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    52. Claim.identifier:INTER.type
                                                    Definition

                                                    A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                    ShortDescription of identifier
                                                    Comments

                                                    This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                    Control1..1
                                                    BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                    (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                                    A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Requirements

                                                    Allows users to make use of identifiers when the identifier system is not known.

                                                    Pattern Value{
                                                      "coding" : [{
                                                        "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType",
                                                        "code" : "INTER",
                                                        "display" : "Intermediary System Identifier"
                                                      }]
                                                    }
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    54. Claim.identifier:INTER.system
                                                    Definition

                                                    Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                    ShortThe namespace for the identifier value
                                                    Comments

                                                    Identifier.system is always case sensitive.

                                                    Control0..1
                                                    Typeuri
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Requirements

                                                    There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                    Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    56. Claim.identifier:INTER.value
                                                    Definition

                                                    The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                    ShortThe value that is unique
                                                    Comments

                                                    If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Example<br/><b>General</b>:123456
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    58. Claim.identifier:INTER.period
                                                    Definition

                                                    Time period during which identifier is/was valid for use.

                                                    ShortTime period when id is/was valid for use
                                                    Control0..1
                                                    TypePeriod
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    60. Claim.identifier:INTER.assigner
                                                    Definition

                                                    Organization that issued/manages the identifier.

                                                    ShortOrganization that issued id (may be just text)
                                                    Comments

                                                    The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                    Control0..1
                                                    TypeReference(Organization)
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    62. Claim.status
                                                    Definition

                                                    The status of the resource instance.

                                                    Shortactive | cancelled | draft | entered-in-error
                                                    Comments

                                                    This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                                                    Control1..1
                                                    BindingThe codes SHALL be taken from FinancialResourceStatusCodes
                                                    (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

                                                    A code specifying the state of the resource instance.

                                                    Typecode
                                                    Is Modifiertrue because 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
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Requirements

                                                    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'.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    64. Claim.type
                                                    Definition

                                                    The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

                                                    ShortCategory or discipline
                                                    Comments

                                                    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.

                                                    Control1..1
                                                    BindingUnless not suitable, these codes SHALL be taken from ClaimTypeCodes
                                                    (extensible to http://hl7.org/fhir/ValueSet/claim-type)

                                                    The type or discipline-style of the claim.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Requirements

                                                    Claim type determine the general sets of business rules applied for information requirements and adjudication.

                                                    Pattern Value{
                                                      "coding" : [{
                                                        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
                                                        "code" : "professional"
                                                      }]
                                                    }
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    66. Claim.subType
                                                    Definition

                                                    A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

                                                    ShortMore granular claim type
                                                    Comments

                                                    This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

                                                    Control0..1
                                                    BindingFor example codes, see ExampleClaimSubTypeCodes
                                                    (example to http://hl7.org/fhir/ValueSet/claim-subtype)

                                                    A more granular claim typecode.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Some jurisdictions need a finer grained claim type for routing and adjudication.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    68. Claim.use
                                                    Definition

                                                    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.

                                                    Shortclaim | preauthorization | predetermination
                                                    Control1..1
                                                    BindingThe codes SHALL be taken from Use
                                                    (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

                                                    The purpose of the Claim: predetermination, preauthorization, claim.

                                                    Typecode
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Requirements

                                                    This element is required to understand the nature of the request for adjudication.

                                                    Pattern Valuepredetermination
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    70. Claim.patient
                                                    Definition

                                                    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.

                                                    ShortThe recipient of the products and services
                                                    Control1..1
                                                    TypeReference(HRex Patient Demographics)
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Requirements

                                                    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.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    72. Claim.billablePeriod
                                                    Definition

                                                    The period for which charges are being submitted.

                                                    ShortRelevant time frame for the claim
                                                    Comments

                                                    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.

                                                    Control0..1
                                                    TypePeriod
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Requirements

                                                    A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    74. Claim.created
                                                    Definition

                                                    The date this resource was created.

                                                    ShortResource creation date
                                                    Comments

                                                    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.

                                                    Control1..1
                                                    TypedateTime
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Requirements

                                                    Need to record a timestamp for use by both the recipient and the issuer.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    76. Claim.enterer
                                                    Definition

                                                    Individual who created the claim, predetermination or preauthorization.

                                                    ShortAuthor of the claim
                                                    Control0..1
                                                    TypeReference(Practitioner, PractitionerRole)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Some jurisdictions require the contact information for personnel completing claims.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    78. Claim.insurer
                                                    Definition

                                                    The Insurer who is target of the request.

                                                    Shorticon Changed:Required if insured estimate
                                                    Controlicon Changed:0..1
                                                    TypeReference(PCT Organization)
                                                    Is Modifierfalse
                                                    Must Supporticon Added:true
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    80. Claim.provider
                                                    Definition

                                                    The provider which is responsible for the claim, predetermination or preauthorization.

                                                    ShortBilling provider - party responsible for the GFE
                                                    Comments

                                                    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.

                                                    Control1..1
                                                    TypeReference(PCT Organization, PCT Practitioner)
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    82. Claim.provider.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    84. Claim.provider.extension
                                                    Definition

                                                    An Extension

                                                    ShortExtension
                                                    Control1..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    SlicingThis element introduces a set of slices on Claim.provider.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 86. Claim.provider.extension:providerTaxonomy
                                                      Slice NameproviderTaxonomy
                                                      Definition

                                                      This extension is used to indicate the taxonomy code of the provider.

                                                      ShortProvider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
                                                      Control1..1
                                                      TypeExtension(ProviderTaxonomy) (Extension Type: CodeableConcept)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      88. Claim.provider.extension:consentForBalanceBilling
                                                      Slice NameconsentForBalanceBilling
                                                      Definition

                                                      If the provider has received a written consent form indicating a patient has agreed to waive their protections and pay up to the full cost for the out-of-network item or service, this will be “true”. If the provider has not received written consent, this will be “false”. This is an attestation only. The billing provider is legally required to maintain the written notice and consent form.

                                                      ShortExtension
                                                      Control0..1
                                                      TypeExtension(GFEConsentForBalanceBilling) (Extension Type: boolean)
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      90. Claim.provider.reference
                                                      Definition

                                                      A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                      ShortLiteral reference, Relative, internal or absolute URL
                                                      Comments

                                                      Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                      Control0..1
                                                      This element is affected by the following invariants: ref-1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      92. Claim.provider.type
                                                      Definition

                                                      The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                      The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                      ShortType the reference refers to (e.g. "Patient")
                                                      Comments

                                                      This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                      Control0..1
                                                      BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                      (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                                      Aa resource (or, for logical models, the URI of the logical model).

                                                      Typeuri
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      94. Claim.provider.identifier
                                                      Definition

                                                      An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                      ShortLogical reference, when literal reference is not known
                                                      Comments

                                                      When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                      When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                      Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                      Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                                      Control0..1
                                                      TypeIdentifier
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      96. Claim.provider.display
                                                      Definition

                                                      Plain text narrative that identifies the resource in addition to the resource reference.

                                                      ShortText alternative for the resource
                                                      Comments

                                                      This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      98. Claim.priority
                                                      Definition

                                                      The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

                                                      ShortDesired processing ugency
                                                      Comments

                                                      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.

                                                      Control1..1
                                                      BindingThe codes SHALL be taken from ProcessPriorityCodes
                                                      (required to http://hl7.org/fhir/ValueSet/process-priority)
                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Requirements

                                                      The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      100. Claim.fundsReserve
                                                      Definition

                                                      A code to indicate whether and for whom funds are to be reserved for future claims.

                                                      ShortFor whom to reserve funds
                                                      Comments

                                                      This field is only used for preauthorizations.

                                                      Control0..1
                                                      BindingFor example codes, see Funds Reservation Codes
                                                      (example to http://hl7.org/fhir/ValueSet/fundsreserve)

                                                      For whom funds are to be reserved: (Patient, Provider, None).

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      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.

                                                      Alternate NamesFund pre-allocation
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      102. Claim.related
                                                      Definition

                                                      Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

                                                      ShortPrior or corollary claims
                                                      Comments

                                                      For example, for the original treatment and follow-up exams.

                                                      Control0..*
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      For workplace or other accidents it is common to relate separate claims arising from the same event.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      104. Claim.related.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      106. Claim.related.extension
                                                      Definition

                                                      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.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      108. Claim.related.modifierExtension
                                                      Definition

                                                      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).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      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.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      110. Claim.related.claim
                                                      Definition

                                                      Reference to a related claim.

                                                      ShortReference to the related claim
                                                      Control0..1
                                                      TypeReference(Claim)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      For workplace or other accidents it is common to relate separate claims arising from the same event.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      112. Claim.related.relationship
                                                      Definition

                                                      A code to convey how the claims are related.

                                                      ShortHow the reference claim is related
                                                      Comments

                                                      For example, prior claim or umbrella.

                                                      Control0..1
                                                      BindingFor example codes, see ExampleRelatedClaimRelationshipCodes
                                                      (example to http://hl7.org/fhir/ValueSet/related-claim-relationship)

                                                      Relationship of this claim to a related Claim.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Some insurers need a declaration of the type of relationship.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      114. Claim.related.reference
                                                      Definition

                                                      An alternate organizational reference to the case or file to which this particular claim pertains.

                                                      ShortFile or case reference
                                                      Comments

                                                      For example, Property/Casualty insurer claim # or Workers Compensation case # .

                                                      Control0..1
                                                      TypeIdentifier
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      116. Claim.prescription
                                                      Definition

                                                      Prescription to support the dispensing of pharmacy, device or vision products.

                                                      ShortPrescription authorizing services and products
                                                      Control0..1
                                                      TypeReference(DeviceRequest, MedicationRequest, VisionPrescription)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Required to authorize the dispensing of controlled substances and devices.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      118. Claim.originalPrescription
                                                      Definition

                                                      Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

                                                      ShortOriginal prescription if superseded by fulfiller
                                                      Comments

                                                      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'.

                                                      Control0..1
                                                      TypeReference(DeviceRequest, MedicationRequest, VisionPrescription)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      120. Claim.payee
                                                      Definition

                                                      The party to be reimbursed for cost of the products and services according to the terms of the policy.

                                                      ShortRecipient of benefits payable
                                                      Comments

                                                      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.

                                                      Control0..1
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Requirements

                                                      The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      122. Claim.payee.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      124. Claim.payee.extension
                                                      Definition

                                                      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.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      126. Claim.payee.modifierExtension
                                                      Definition

                                                      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).

                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                      Summarytrue
                                                      Requirements

                                                      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.

                                                      Alternate Namesextensions, user content, modifiers
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      128. Claim.payee.type
                                                      Definition

                                                      Type of Party to be reimbursed: subscriber, provider, other.

                                                      ShortCategory of recipient
                                                      Control1..1
                                                      BindingFor example codes, see Claim Payee Type Codes
                                                      (example to http://hl7.org/fhir/ValueSet/payeetype)

                                                      A code for the party to be reimbursed.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      130. Claim.payee.party
                                                      Definition

                                                      Reference to the individual or organization to whom any payment will be made.

                                                      ShortRecipient reference
                                                      Comments

                                                      Not required if the payee is 'subscriber' or 'provider'.

                                                      Control0..1
                                                      TypeReference(PCT Practitioner, PCT Organization)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      132. Claim.referral
                                                      Definition

                                                      A reference to a referral resource.

                                                      ShortTreatment referral
                                                      Comments

                                                      The referral resource which lists the date, practitioner, reason and other supporting information.

                                                      Control0..1
                                                      TypeReference(ServiceRequest)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Some insurers require proof of referral to pay for services or to pay specialist rates for services.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      134. Claim.referral.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      136. Claim.referral.extension
                                                      Definition

                                                      An Extension

                                                      ShortExtension
                                                      Control1..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      SlicingThis element introduces a set of slices on Claim.referral.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 138. Claim.referral.extension:referralNumber
                                                        Slice NamereferralNumber
                                                        Definition

                                                        This extension is used to provide the Referral Number.

                                                        ShortReferral Number
                                                        Control1..1
                                                        TypeExtension(ReferralNumber) (Extension Type: string)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                        140. Claim.referral.reference
                                                        Definition

                                                        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                        ShortLiteral reference, Relative, internal or absolute URL
                                                        Comments

                                                        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                        Control0..1
                                                        This element is affected by the following invariants: ref-1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        142. Claim.referral.type
                                                        Definition

                                                        The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                        The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                        ShortType the reference refers to (e.g. "Patient")
                                                        Comments

                                                        This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                        Control0..1
                                                        BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                        (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                                        Aa resource (or, for logical models, the URI of the logical model).

                                                        Typeuri
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        144. Claim.referral.identifier
                                                        Definition

                                                        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                        ShortLogical reference, when literal reference is not known
                                                        Comments

                                                        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                                        Control0..1
                                                        TypeIdentifier
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        146. Claim.referral.display
                                                        Definition

                                                        Plain text narrative that identifies the resource in addition to the resource reference.

                                                        ShortText alternative for the resource
                                                        Comments

                                                        This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        148. Claim.facility
                                                        Definition

                                                        Facility where the services were provided.

                                                        ShortServicing facility
                                                        Control0..1
                                                        TypeReference(Location)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Requirements

                                                        Insurance adjudication can be dependant on where services were delivered.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        150. Claim.careTeam
                                                        Definition

                                                        The members of the team who provided the products and services.

                                                        ShortMembers of the care team
                                                        Control0..*
                                                        TypeBackboneElement
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summaryfalse
                                                        Requirements

                                                        Common to identify the responsible and supporting practitioners.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        SlicingThis element introduces a set of slices on Claim.careTeam. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ role
                                                        • 152. Claim.careTeam.id
                                                          Definition

                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          154. Claim.careTeam.extension
                                                          Definition

                                                          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.

                                                          ShortAdditional content defined by implementations
                                                          Comments

                                                          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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          156. Claim.careTeam.modifierExtension
                                                          Definition

                                                          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).

                                                          ShortExtensions that cannot be ignored even if unrecognized
                                                          Comments

                                                          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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                          Summarytrue
                                                          Requirements

                                                          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.

                                                          Alternate Namesextensions, user content, modifiers
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          158. Claim.careTeam.sequence
                                                          Definition

                                                          A number to uniquely identify care team entries.

                                                          ShortOrder of care team
                                                          Control1..1
                                                          TypepositiveInt
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summaryfalse
                                                          Requirements

                                                          Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          160. Claim.careTeam.provider
                                                          Definition

                                                          Member of the team who provided the product or service.

                                                          ShortPractitioner or organization
                                                          Control1..1
                                                          TypeReference(PCT Practitioner, PCT Organization)
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Often a regulatory requirement to specify the responsible provider.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          162. Claim.careTeam.responsible
                                                          Definition

                                                          The party who is billing and/or responsible for the claimed products or services.

                                                          ShortIndicator of the lead practitioner
                                                          Comments

                                                          Responsible might not be required when there is only a single provider listed.

                                                          Control0..1
                                                          Typeboolean
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summaryfalse
                                                          Requirements

                                                          When multiple parties are present it is required to distinguish the lead or responsible individual.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          164. Claim.careTeam.role
                                                          Definition

                                                          The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

                                                          ShortFunction within the team
                                                          Comments

                                                          Role might not be required when there is only a single provider listed.

                                                          Control1..1
                                                          BindingThe codes SHALL be taken from PCT Care Team Role Value Set
                                                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS)
                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          When multiple parties are present it is required to distinguish the roles performed by each member.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          166. Claim.careTeam.qualification
                                                          Definition

                                                          The qualification of the practitioner which is applicable for this service.

                                                          ShortPractitioner credential or specialization
                                                          Control0..1
                                                          BindingThe codes SHALL be taken from US Core Provider Role (NUCC)
                                                          (required to http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role)
                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Need to specify which qualification a provider is delivering the product or service under.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          168. Claim.careTeam:rendering
                                                          Slice Namerendering
                                                          Definition

                                                          The members of the team who provided the products and services.

                                                          ShortMembers of the care team
                                                          Control0..*
                                                          TypeBackboneElement
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Common to identify the responsible and supporting practitioners.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          170. Claim.careTeam:rendering.id
                                                          Definition

                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          172. Claim.careTeam:rendering.extension
                                                          Definition

                                                          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.

                                                          ShortAdditional content defined by implementations
                                                          Comments

                                                          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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          174. Claim.careTeam:rendering.modifierExtension
                                                          Definition

                                                          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).

                                                          ShortExtensions that cannot be ignored even if unrecognized
                                                          Comments

                                                          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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                          Summarytrue
                                                          Requirements

                                                          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.

                                                          Alternate Namesextensions, user content, modifiers
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          176. Claim.careTeam:rendering.sequence
                                                          Definition

                                                          A number to uniquely identify care team entries.

                                                          ShortOrder of care team
                                                          Control1..1
                                                          TypepositiveInt
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summaryfalse
                                                          Requirements

                                                          Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          178. Claim.careTeam:rendering.provider
                                                          Definition

                                                          Member of the team who provided the product or service.

                                                          ShortPractitioner or organization
                                                          Control1..1
                                                          TypeReference(PCT Practitioner, PCT Organization)
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Often a regulatory requirement to specify the responsible provider.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          180. Claim.careTeam:rendering.responsible
                                                          Definition

                                                          The party who is billing and/or responsible for the claimed products or services.

                                                          ShortIndicator of the lead practitioner
                                                          Comments

                                                          Responsible might not be required when there is only a single provider listed.

                                                          Control0..1
                                                          Typeboolean
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summaryfalse
                                                          Requirements

                                                          When multiple parties are present it is required to distinguish the lead or responsible individual.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          182. Claim.careTeam:rendering.role
                                                          Definition

                                                          The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

                                                          ShortFunction within the team
                                                          Comments

                                                          Role might not be required when there is only a single provider listed.

                                                          Control1..1
                                                          BindingThe codes SHALL be taken from PCT Care Team Role Value Set
                                                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS)
                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          When multiple parties are present it is required to distinguish the roles performed by each member.

                                                          Pattern Value{
                                                            "coding" : [{
                                                              "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
                                                              "code" : "rendering"
                                                            }]
                                                          }
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          184. Claim.careTeam:rendering.qualification
                                                          Definition

                                                          The qualification of the practitioner which is applicable for this service.

                                                          ShortPractitioner credential or specialization - must provide a taxonomy code for the Professional case
                                                          Control1..1
                                                          BindingThe codes SHALL be taken from US Core Provider Role (NUCC)
                                                          (required to http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role)
                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Need to specify which qualification a provider is delivering the product or service under.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          186. Claim.careTeam:referring
                                                          Slice Namereferring
                                                          Definition

                                                          The members of the team who provided the products and services.

                                                          ShortMembers of the care team
                                                          Control0..1
                                                          TypeBackboneElement
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Common to identify the responsible and supporting practitioners.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          188. Claim.careTeam:referring.id
                                                          Definition

                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          190. Claim.careTeam:referring.extension
                                                          Definition

                                                          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.

                                                          ShortAdditional content defined by implementations
                                                          Comments

                                                          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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          192. Claim.careTeam:referring.modifierExtension
                                                          Definition

                                                          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).

                                                          ShortExtensions that cannot be ignored even if unrecognized
                                                          Comments

                                                          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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                          Summarytrue
                                                          Requirements

                                                          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.

                                                          Alternate Namesextensions, user content, modifiers
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          194. Claim.careTeam:referring.sequence
                                                          Definition

                                                          A number to uniquely identify care team entries.

                                                          ShortOrder of care team
                                                          Control1..1
                                                          TypepositiveInt
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summaryfalse
                                                          Requirements

                                                          Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          196. Claim.careTeam:referring.provider
                                                          Definition

                                                          Member of the team who provided the product or service.

                                                          ShortPractitioner or organization
                                                          Control1..1
                                                          TypeReference(PCT Practitioner, PCT Organization)
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Often a regulatory requirement to specify the responsible provider.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          198. Claim.careTeam:referring.responsible
                                                          Definition

                                                          The party who is billing and/or responsible for the claimed products or services.

                                                          ShortIndicator of the lead practitioner
                                                          Comments

                                                          Responsible might not be required when there is only a single provider listed.

                                                          Control0..1
                                                          Typeboolean
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summaryfalse
                                                          Requirements

                                                          When multiple parties are present it is required to distinguish the lead or responsible individual.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          200. Claim.careTeam:referring.role
                                                          Definition

                                                          The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

                                                          ShortFunction within the team
                                                          Comments

                                                          Role might not be required when there is only a single provider listed.

                                                          Control1..1
                                                          BindingThe codes SHALL be taken from PCT Care Team Role Value Set
                                                          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS)
                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          When multiple parties are present it is required to distinguish the roles performed by each member.

                                                          Pattern Value{
                                                            "coding" : [{
                                                              "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
                                                              "code" : "referring"
                                                            }]
                                                          }
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          202. Claim.careTeam:referring.qualification
                                                          Definition

                                                          The qualification of the practitioner which is applicable for this service.

                                                          ShortPractitioner credential or specialization
                                                          Control0..1
                                                          BindingThe codes SHALL be taken from US Core Provider Role (NUCC)
                                                          (required to http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role)
                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Need to specify which qualification a provider is delivering the product or service under.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          204. Claim.supportingInfo
                                                          Definition

                                                          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                                          ShortSupporting information
                                                          Comments

                                                          Often there are multiple jurisdiction specific valuesets which are required.

                                                          Control0..*
                                                          TypeBackboneElement
                                                          Is Modifierfalse
                                                          Must Supporttrue
                                                          Summaryfalse
                                                          Requirements

                                                          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                                          Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          SlicingThis element introduces a set of slices on Claim.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ category
                                                          • 206. Claim.supportingInfo.id
                                                            Definition

                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                            ShortUnique id for inter-element referencing
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Summaryfalse
                                                            208. Claim.supportingInfo.extension
                                                            Definition

                                                            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.

                                                            ShortAdditional content defined by implementations
                                                            Comments

                                                            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.

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Alternate Namesextensions, user content
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            210. Claim.supportingInfo.modifierExtension
                                                            Definition

                                                            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).

                                                            ShortExtensions that cannot be ignored even if unrecognized
                                                            Comments

                                                            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.

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                            Summarytrue
                                                            Requirements

                                                            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.

                                                            Alternate Namesextensions, user content, modifiers
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            212. Claim.supportingInfo.sequence
                                                            Definition

                                                            A number to uniquely identify supporting information entries.

                                                            ShortInformation instance identifier
                                                            Control1..1
                                                            TypepositiveInt
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summaryfalse
                                                            Requirements

                                                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            214. Claim.supportingInfo.category
                                                            Definition

                                                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                                            ShortClassification of the supplied information
                                                            Comments

                                                            This may contain a category for the local bill type codes.

                                                            Control1..1
                                                            BindingUnless not suitable, these codes SHALL be taken from PCT Supporting Info Type Value Set
                                                            (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS)
                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Requirements

                                                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            216. Claim.supportingInfo.code
                                                            Definition

                                                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                                            ShortType of information
                                                            Control0..1
                                                            BindingFor example codes, see ExceptionCodes
                                                            (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                                            The valuset used for additional information codes.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Requirements

                                                            Required to identify the kind of additional information.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            218. Claim.supportingInfo.timing[x]
                                                            Definition

                                                            The date when or period to which this information refers.

                                                            ShortWhen it occurred
                                                            Control0..1
                                                            TypeChoice of: date, Period
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            220. Claim.supportingInfo.value[x]
                                                            Definition

                                                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                            ShortData to be provided
                                                            Comments

                                                            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.

                                                            Control0..1
                                                            TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summaryfalse
                                                            Requirements

                                                            To convey the data content to be provided when the information is more than a simple code or period.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            222. Claim.supportingInfo.reason
                                                            Definition

                                                            Provides the reason in the situation where a reason code is required in addition to the content.

                                                            ShortExplanation for the information
                                                            Comments

                                                            For example: the reason for the additional stay, or why a tooth is missing.

                                                            Control0..1
                                                            BindingFor example codes, see MissingToothReasonCodes
                                                            (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                                            Reason codes for the missing teeth.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Requirements

                                                            Needed when the supporting information has both a date and amount/value and requires explanation.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            224. Claim.supportingInfo:serviceFacility
                                                            Slice NameserviceFacility
                                                            Definition

                                                            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                                            ShortService Facility
                                                            Comments

                                                            Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider.

                                                            Control0..1
                                                            TypeBackboneElement
                                                            Is Modifierfalse
                                                            Must Supporttrue
                                                            Summaryfalse
                                                            Requirements

                                                            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                                            Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            226. Claim.supportingInfo:serviceFacility.id
                                                            Definition

                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                            ShortUnique id for inter-element referencing
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Summaryfalse
                                                            228. Claim.supportingInfo:serviceFacility.extension
                                                            Definition

                                                            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.

                                                            ShortAdditional content defined by implementations
                                                            Comments

                                                            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.

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Alternate Namesextensions, user content
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            230. Claim.supportingInfo:serviceFacility.modifierExtension
                                                            Definition

                                                            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).

                                                            ShortExtensions that cannot be ignored even if unrecognized
                                                            Comments

                                                            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.

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                            Summarytrue
                                                            Requirements

                                                            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.

                                                            Alternate Namesextensions, user content, modifiers
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            232. Claim.supportingInfo:serviceFacility.sequence
                                                            Definition

                                                            A number to uniquely identify supporting information entries.

                                                            ShortInformation instance identifier
                                                            Control1..1
                                                            TypepositiveInt
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summaryfalse
                                                            Requirements

                                                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            234. Claim.supportingInfo:serviceFacility.category
                                                            Definition

                                                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                                            ShortClassification of the supplied information
                                                            Comments

                                                            This may contain a category for the local bill type codes.

                                                            Control1..1
                                                            BindingUnless not suitable, these codes SHALL be taken from PCT Supporting Info Type Value Set
                                                            (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS)
                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Requirements

                                                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                                            Pattern Value{
                                                              "coding" : [{
                                                                "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
                                                                "code" : "servicefacility"
                                                              }]
                                                            }
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            236. Claim.supportingInfo:serviceFacility.code
                                                            Definition

                                                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                                            ShortType of information
                                                            Control0..1
                                                            BindingFor example codes, see ExceptionCodes
                                                            (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                                            The valuset used for additional information codes.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Requirements

                                                            Required to identify the kind of additional information.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            238. Claim.supportingInfo:serviceFacility.timing[x]
                                                            Definition

                                                            The date when or period to which this information refers.

                                                            ShortWhen it occurred
                                                            Control0..1
                                                            TypeChoice of: date, Period
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            240. Claim.supportingInfo:serviceFacility.value[x]
                                                            Definition

                                                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                            ShortData to be provided
                                                            Comments

                                                            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.

                                                            Control1..1
                                                            TypeReference(Resource)
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Requirements

                                                            To convey the data content to be provided when the information is more than a simple code or period.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            SlicingThis element introduces a set of slices on Claim.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                            • type @ $this
                                                            • 242. Claim.supportingInfo:serviceFacility.value[x]:valueReference
                                                              Slice NamevalueReference
                                                              Definition

                                                              Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                              ShortData to be provided
                                                              Comments

                                                              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.

                                                              Control1..1
                                                              TypeReference(PCT Organization)
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Requirements

                                                              To convey the data content to be provided when the information is more than a simple code or period.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              244. Claim.supportingInfo:serviceFacility.reason
                                                              Definition

                                                              Provides the reason in the situation where a reason code is required in addition to the content.

                                                              ShortExplanation for the information
                                                              Comments

                                                              For example: the reason for the additional stay, or why a tooth is missing.

                                                              Control0..1
                                                              BindingFor example codes, see MissingToothReasonCodes
                                                              (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                                              Reason codes for the missing teeth.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Requirements

                                                              Needed when the supporting information has both a date and amount/value and requires explanation.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              246. Claim.supportingInfo:claimFrequency
                                                              Slice NameclaimFrequency
                                                              Definition

                                                              Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                                              ShortClaim Frequency
                                                              Comments

                                                              Claim frequency - uses the last digit of the NUBC type of billing code.

                                                              Control0..1
                                                              TypeBackboneElement
                                                              Is Modifierfalse
                                                              Must Supporttrue
                                                              Summaryfalse
                                                              Requirements

                                                              Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                                              Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              248. Claim.supportingInfo:claimFrequency.id
                                                              Definition

                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              250. Claim.supportingInfo:claimFrequency.extension
                                                              Definition

                                                              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.

                                                              ShortAdditional content defined by implementations
                                                              Comments

                                                              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.

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Alternate Namesextensions, user content
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                              252. Claim.supportingInfo:claimFrequency.modifierExtension
                                                              Definition

                                                              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).

                                                              ShortExtensions that cannot be ignored even if unrecognized
                                                              Comments

                                                              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.

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                              Summarytrue
                                                              Requirements

                                                              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.

                                                              Alternate Namesextensions, user content, modifiers
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                              254. Claim.supportingInfo:claimFrequency.sequence
                                                              Definition

                                                              A number to uniquely identify supporting information entries.

                                                              ShortInformation instance identifier
                                                              Control1..1
                                                              TypepositiveInt
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summaryfalse
                                                              Requirements

                                                              Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              256. Claim.supportingInfo:claimFrequency.category
                                                              Definition

                                                              The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                                              ShortClassification of the supplied information
                                                              Comments

                                                              This may contain a category for the local bill type codes.

                                                              Control1..1
                                                              BindingUnless not suitable, these codes SHALL be taken from PCT Supporting Info Type Value Set
                                                              (extensible to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTSupportingInfoTypeVS)
                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Requirements

                                                              Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                                              Pattern Value{
                                                                "coding" : [{
                                                                  "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
                                                                  "code" : "claimFrequency"
                                                                }]
                                                              }
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              258. Claim.supportingInfo:claimFrequency.code
                                                              Definition

                                                              System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                                              ShortType of information
                                                              Control1..1
                                                              BindingThe codes SHALL be taken from PCT GFE Frequency Code Value Set
                                                              (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEFrequencyVS)
                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Requirements

                                                              Required to identify the kind of additional information.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              260. Claim.supportingInfo:claimFrequency.timing[x]
                                                              Definition

                                                              The date when or period to which this information refers.

                                                              ShortWhen it occurred
                                                              Control0..1
                                                              TypeChoice of: date, Period
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              262. Claim.supportingInfo:claimFrequency.value[x]
                                                              Definition

                                                              Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                                              ShortData to be provided
                                                              Comments

                                                              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.

                                                              Control0..1
                                                              TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summaryfalse
                                                              Requirements

                                                              To convey the data content to be provided when the information is more than a simple code or period.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              264. Claim.supportingInfo:claimFrequency.reason
                                                              Definition

                                                              Provides the reason in the situation where a reason code is required in addition to the content.

                                                              ShortExplanation for the information
                                                              Comments

                                                              For example: the reason for the additional stay, or why a tooth is missing.

                                                              Control0..1
                                                              BindingFor example codes, see MissingToothReasonCodes
                                                              (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                                              Reason codes for the missing teeth.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Requirements

                                                              Needed when the supporting information has both a date and amount/value and requires explanation.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              266. Claim.diagnosis
                                                              Definition

                                                              Information about diagnoses relevant to the claim items.

                                                              ShortPertinent diagnosis information
                                                              Control0..*
                                                              TypeBackboneElement
                                                              Is Modifierfalse
                                                              Must Supporttrue
                                                              Summaryfalse
                                                              Requirements

                                                              Required for the adjudication by provided context for the services and product listed.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              SlicingThis element introduces a set of slices on Claim.diagnosis. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ type
                                                              • 268. Claim.diagnosis.id
                                                                Definition

                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                ShortUnique id for inter-element referencing
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                270. Claim.diagnosis.extension
                                                                Definition

                                                                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.

                                                                ShortAdditional content defined by implementations
                                                                Comments

                                                                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.

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Alternate Namesextensions, user content
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                272. Claim.diagnosis.modifierExtension
                                                                Definition

                                                                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).

                                                                ShortExtensions that cannot be ignored even if unrecognized
                                                                Comments

                                                                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.

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                Summarytrue
                                                                Requirements

                                                                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.

                                                                Alternate Namesextensions, user content, modifiers
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                274. Claim.diagnosis.sequence
                                                                Definition

                                                                A number to uniquely identify diagnosis entries.

                                                                ShortDiagnosis instance identifier
                                                                Comments

                                                                Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                                                                Control1..1
                                                                TypepositiveInt
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summaryfalse
                                                                Requirements

                                                                Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                276. Claim.diagnosis.diagnosis[x]
                                                                Definition

                                                                The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                                                ShortNature of illness or problem
                                                                Control1..1
                                                                BindingFor example codes, see ICD-10Codes
                                                                (example to http://hl7.org/fhir/ValueSet/icd-10)

                                                                Example ICD10 Diagnostic codes.

                                                                TypeChoice of: CodeableConcept, Reference(Condition)
                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

                                                                Provides health context for the evaluation of the products and/or services.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                278. Claim.diagnosis.type
                                                                Definition

                                                                When the condition was observed or the relative ranking.

                                                                ShortTiming or nature of the diagnosis
                                                                Comments

                                                                For example: admitting, primary, secondary, discharge.

                                                                Control0..*
                                                                BindingThe codes SHALL be taken from PCT Diagnosis Type Value Set
                                                                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS)
                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summaryfalse
                                                                Requirements

                                                                Often required to capture a particular diagnosis, for example: primary or discharge.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                280. Claim.diagnosis.onAdmission
                                                                Definition

                                                                Indication of whether the diagnosis was present on admission to a facility.

                                                                ShortPresent on admission
                                                                Control0..1
                                                                BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                                                (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                                                Present on admission.

                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

                                                                Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                282. Claim.diagnosis.packageCode
                                                                Definition

                                                                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.

                                                                ShortPackage billing code
                                                                Comments

                                                                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.

                                                                Control0..1
                                                                BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                                                (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                                                The DRG codes associated with the diagnosis.

                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

                                                                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.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                284. Claim.diagnosis:principal
                                                                Slice Nameprincipal
                                                                Definition

                                                                Information about diagnoses relevant to the claim items.

                                                                ShortPrincipal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
                                                                Comments

                                                                If the Principal Diagnosis code is known, it is important that it be shared in the GFE, particularly when the GFE is being sent to a payer for an insured patient. Payers very often need the diagnosis to be able to provide an estimate. Without the diagnosis, payers may assume the service is diagnostic and thus the patient responsibility may be higher or not covered at all than the diagnosis, such as for preventative services, would otherwise indicate. It is understood that in certain situations, such as scheduled services or GFE requests prior to orders, diagnosis is not needed or may not yet be known. However, when it is known, it is important that this information be shared to ensure the best possible estimate is provided to the patient.

                                                                Control0..1
                                                                TypeBackboneElement
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summaryfalse
                                                                Requirements

                                                                Required for the adjudication by provided context for the services and product listed.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                286. Claim.diagnosis:principal.id
                                                                Definition

                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                ShortUnique id for inter-element referencing
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                288. Claim.diagnosis:principal.extension
                                                                Definition

                                                                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.

                                                                ShortAdditional content defined by implementations
                                                                Comments

                                                                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.

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Alternate Namesextensions, user content
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                290. Claim.diagnosis:principal.modifierExtension
                                                                Definition

                                                                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).

                                                                ShortExtensions that cannot be ignored even if unrecognized
                                                                Comments

                                                                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.

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                Summarytrue
                                                                Requirements

                                                                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.

                                                                Alternate Namesextensions, user content, modifiers
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                292. Claim.diagnosis:principal.sequence
                                                                Definition

                                                                A number to uniquely identify diagnosis entries.

                                                                ShortDiagnosis instance identifier
                                                                Comments

                                                                Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                                                                Control1..1
                                                                TypepositiveInt
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summaryfalse
                                                                Requirements

                                                                Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                                                Pattern Value1
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                294. Claim.diagnosis:principal.diagnosis[x]
                                                                Definition

                                                                The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                                                ShortNature of illness or problem
                                                                Control1..1
                                                                BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
                                                                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes)
                                                                TypeCodeableConcept
                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

                                                                Provides health context for the evaluation of the products and/or services.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                296. Claim.diagnosis:principal.type
                                                                Definition

                                                                When the condition was observed or the relative ranking.

                                                                ShortTiming or nature of the diagnosis
                                                                Comments

                                                                For example: admitting, primary, secondary, discharge.

                                                                Control1..1
                                                                BindingThe codes SHALL be taken from PCT Diagnosis Type Value Set
                                                                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS)
                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summaryfalse
                                                                Requirements

                                                                Often required to capture a particular diagnosis, for example: primary or discharge.

                                                                Pattern Value{
                                                                  "coding" : [{
                                                                    "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                                                                    "code" : "principal"
                                                                  }]
                                                                }
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                298. Claim.diagnosis:principal.onAdmission
                                                                Definition

                                                                Indication of whether the diagnosis was present on admission to a facility.

                                                                ShortPresent on admission
                                                                Control0..1
                                                                BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                                                (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                                                Present on admission.

                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

                                                                Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                300. Claim.diagnosis:principal.packageCode
                                                                Definition

                                                                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.

                                                                ShortPackage billing code
                                                                Comments

                                                                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.

                                                                Control0..1
                                                                BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                                                (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                                                The DRG codes associated with the diagnosis.

                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

                                                                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.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                302. Claim.diagnosis:other
                                                                Slice Nameother
                                                                Definition

                                                                Information about diagnoses relevant to the claim items.

                                                                ShortPertinent diagnosis information
                                                                Control0..11
                                                                TypeBackboneElement
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summaryfalse
                                                                Requirements

                                                                Required for the adjudication by provided context for the services and product listed.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                304. Claim.diagnosis:other.id
                                                                Definition

                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                ShortUnique id for inter-element referencing
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                306. Claim.diagnosis:other.extension
                                                                Definition

                                                                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.

                                                                ShortAdditional content defined by implementations
                                                                Comments

                                                                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.

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Alternate Namesextensions, user content
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                308. Claim.diagnosis:other.modifierExtension
                                                                Definition

                                                                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).

                                                                ShortExtensions that cannot be ignored even if unrecognized
                                                                Comments

                                                                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.

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                Summarytrue
                                                                Requirements

                                                                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.

                                                                Alternate Namesextensions, user content, modifiers
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                310. Claim.diagnosis:other.sequence
                                                                Definition

                                                                A number to uniquely identify diagnosis entries.

                                                                ShortDiagnosis instance identifier
                                                                Comments

                                                                Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                                                                Control1..1
                                                                TypepositiveInt
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summaryfalse
                                                                Requirements

                                                                Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                312. Claim.diagnosis:other.diagnosis[x]
                                                                Definition

                                                                The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                                                ShortNature of illness or problem
                                                                Control1..1
                                                                BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
                                                                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes)
                                                                TypeCodeableConcept
                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

                                                                Provides health context for the evaluation of the products and/or services.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                314. Claim.diagnosis:other.type
                                                                Definition

                                                                When the condition was observed or the relative ranking.

                                                                ShortTiming or nature of the diagnosis
                                                                Comments

                                                                For example: admitting, primary, secondary, discharge.

                                                                Control1..1
                                                                BindingThe codes SHALL be taken from PCT Diagnosis Type Value Set
                                                                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS)
                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summaryfalse
                                                                Requirements

                                                                Often required to capture a particular diagnosis, for example: primary or discharge.

                                                                Pattern Value{
                                                                  "coding" : [{
                                                                    "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
                                                                    "code" : "other"
                                                                  }]
                                                                }
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                316. Claim.diagnosis:other.onAdmission
                                                                Definition

                                                                Indication of whether the diagnosis was present on admission to a facility.

                                                                ShortPresent on admission
                                                                Control0..1
                                                                BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                                                (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                                                Present on admission.

                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

                                                                Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                318. Claim.diagnosis:other.packageCode
                                                                Definition

                                                                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.

                                                                ShortPackage billing code
                                                                Comments

                                                                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.

                                                                Control0..1
                                                                BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                                                (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                                                The DRG codes associated with the diagnosis.

                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

                                                                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.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                320. Claim.procedure
                                                                Definition

                                                                Procedures performed on the patient relevant to the billing items with the claim.

                                                                ShortClinical procedures performed
                                                                Control0..*
                                                                TypeBackboneElement
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summaryfalse
                                                                Requirements

                                                                The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                SlicingThis element introduces a set of slices on Claim.procedure. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ type
                                                                • 322. Claim.procedure.id
                                                                  Definition

                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                  ShortUnique id for inter-element referencing
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                  Summaryfalse
                                                                  324. Claim.procedure.extension
                                                                  Definition

                                                                  An Extension

                                                                  ShortExtension
                                                                  Control1..*
                                                                  TypeExtension
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                  SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 326. Claim.procedure.extension:serviceDescription
                                                                    Slice NameserviceDescription
                                                                    Definition

                                                                    This extension is used to communicate a plain language description of the procedure, product, or service.

                                                                    ShortService Description
                                                                    Control1..1
                                                                    This element is affected by the following invariants: ele-1
                                                                    TypeExtension(Service Description) (Extension Type: string)
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                    328. Claim.procedure.modifierExtension
                                                                    Definition

                                                                    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).

                                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                                    Comments

                                                                    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.

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                    Summarytrue
                                                                    Requirements

                                                                    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.

                                                                    Alternate Namesextensions, user content, modifiers
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                    330. Claim.procedure.sequence
                                                                    Definition

                                                                    A number to uniquely identify procedure entries.

                                                                    ShortProcedure instance identifier
                                                                    Control1..1
                                                                    TypepositiveInt
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summaryfalse
                                                                    Requirements

                                                                    Necessary to provide a mechanism to link to claim details.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    332. Claim.procedure.type
                                                                    Definition

                                                                    When the condition was observed or the relative ranking.

                                                                    ShortCategory of Procedure
                                                                    Comments

                                                                    For example: primary, secondary.

                                                                    Control0..*
                                                                    BindingThe codes SHALL be taken from PCT Procedure Type Value Set
                                                                    (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS)
                                                                    TypeCodeableConcept
                                                                    Is Modifierfalse
                                                                    Must Supporttrue
                                                                    Summaryfalse
                                                                    Requirements

                                                                    Often required to capture a particular diagnosis, for example: primary or discharge.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    334. Claim.procedure.date
                                                                    Definition

                                                                    Date and optionally time the procedure was performed.

                                                                    ShortWhen the procedure was performed
                                                                    Control0..1
                                                                    TypedateTime
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summaryfalse
                                                                    Requirements

                                                                    Required for auditing purposes.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    336. Claim.procedure.procedure[x]
                                                                    Definition

                                                                    The code or reference to a Procedure resource which identifies the clinical intervention performed.

                                                                    ShortSpecific clinical procedure
                                                                    Control1..1
                                                                    BindingFor example codes, see ICD-10ProcedureCodes
                                                                    (example to http://hl7.org/fhir/ValueSet/icd-10-procedures)

                                                                    Example ICD10 Procedure codes.

                                                                    TypeChoice of: CodeableConcept, Reference(Procedure)
                                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Requirements

                                                                    This identifies the actual clinical procedure.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    338. Claim.procedure.udi
                                                                    Definition

                                                                    Unique Device Identifiers associated with this line item.

                                                                    ShortUnique device identifier
                                                                    Control0..*
                                                                    TypeReference(Device)
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Requirements

                                                                    The UDI code allows the insurer to obtain device level information on the product supplied.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    340. Claim.procedure:anesthesiaRelated
                                                                    Slice NameanesthesiaRelated
                                                                    Definition

                                                                    Procedures performed on the patient relevant to the billing items with the claim.

                                                                    ShortClinical procedures performed
                                                                    Control0..2
                                                                    TypeBackboneElement
                                                                    Is Modifierfalse
                                                                    Must Supporttrue
                                                                    Summaryfalse
                                                                    Requirements

                                                                    The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    342. Claim.procedure:anesthesiaRelated.id
                                                                    Definition

                                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                    ShortUnique id for inter-element referencing
                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    Summaryfalse
                                                                    344. Claim.procedure:anesthesiaRelated.extension
                                                                    Definition

                                                                    An Extension

                                                                    ShortExtension
                                                                    Control1..*
                                                                    TypeExtension
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                    SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 346. Claim.procedure:anesthesiaRelated.extension:serviceDescription
                                                                      Slice NameserviceDescription
                                                                      Definition

                                                                      This extension is used to communicate a plain language description of the procedure, product, or service.

                                                                      ShortService Description
                                                                      Control1..1
                                                                      This element is affected by the following invariants: ele-1
                                                                      TypeExtension(Service Description) (Extension Type: string)
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                      348. Claim.procedure:anesthesiaRelated.modifierExtension
                                                                      Definition

                                                                      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).

                                                                      ShortExtensions that cannot be ignored even if unrecognized
                                                                      Comments

                                                                      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.

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                      Summarytrue
                                                                      Requirements

                                                                      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.

                                                                      Alternate Namesextensions, user content, modifiers
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                      350. Claim.procedure:anesthesiaRelated.sequence
                                                                      Definition

                                                                      A number to uniquely identify procedure entries.

                                                                      ShortProcedure instance identifier
                                                                      Control1..1
                                                                      TypepositiveInt
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summaryfalse
                                                                      Requirements

                                                                      Necessary to provide a mechanism to link to claim details.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      352. Claim.procedure:anesthesiaRelated.type
                                                                      Definition

                                                                      When the condition was observed or the relative ranking.

                                                                      ShortCategory of Procedure
                                                                      Comments

                                                                      For example: primary, secondary.

                                                                      Control1..1
                                                                      BindingThe codes SHALL be taken from PCT Procedure Type Value Set
                                                                      (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS)
                                                                      TypeCodeableConcept
                                                                      Is Modifierfalse
                                                                      Must Supporttrue
                                                                      Summaryfalse
                                                                      Requirements

                                                                      Often required to capture a particular diagnosis, for example: primary or discharge.

                                                                      Pattern Value{
                                                                        "coding" : [{
                                                                          "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                                                                          "code" : "procedureRequiringAnesthesia"
                                                                        }]
                                                                      }
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      354. Claim.procedure:anesthesiaRelated.date
                                                                      Definition

                                                                      Date and optionally time the procedure was performed.

                                                                      ShortWhen the procedure was performed
                                                                      Control0..1
                                                                      TypedateTime
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summaryfalse
                                                                      Requirements

                                                                      Required for auditing purposes.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      356. Claim.procedure:anesthesiaRelated.procedure[x]
                                                                      Definition

                                                                      The code or reference to a Procedure resource which identifies the clinical intervention performed.

                                                                      ShortSpecific clinical procedure
                                                                      Control1..1
                                                                      BindingThe codes SHALL be taken from PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
                                                                      (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes)
                                                                      TypeCodeableConcept
                                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Requirements

                                                                      This identifies the actual clinical procedure.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      358. Claim.procedure:anesthesiaRelated.udi
                                                                      Definition

                                                                      Unique Device Identifiers associated with this line item.

                                                                      ShortUnique device identifier
                                                                      Control0..*
                                                                      TypeReference(Device)
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Requirements

                                                                      The UDI code allows the insurer to obtain device level information on the product supplied.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      360. Claim.procedure:other
                                                                      Slice Nameother
                                                                      Definition

                                                                      Procedures performed on the patient relevant to the billing items with the claim.

                                                                      ShortClinical procedures performed
                                                                      Control0..24
                                                                      TypeBackboneElement
                                                                      Is Modifierfalse
                                                                      Must Supporttrue
                                                                      Summaryfalse
                                                                      Requirements

                                                                      The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      362. Claim.procedure:other.id
                                                                      Definition

                                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                      ShortUnique id for inter-element referencing
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      Summaryfalse
                                                                      364. Claim.procedure:other.extension
                                                                      Definition

                                                                      An Extension

                                                                      ShortExtension
                                                                      Control1..*
                                                                      TypeExtension
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                      SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 366. Claim.procedure:other.extension:serviceDescription
                                                                        Slice NameserviceDescription
                                                                        Definition

                                                                        This extension is used to communicate a plain language description of the procedure, product, or service.

                                                                        ShortService Description
                                                                        Control1..1
                                                                        This element is affected by the following invariants: ele-1
                                                                        TypeExtension(Service Description) (Extension Type: string)
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        368. Claim.procedure:other.modifierExtension
                                                                        Definition

                                                                        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).

                                                                        ShortExtensions that cannot be ignored even if unrecognized
                                                                        Comments

                                                                        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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                        Summarytrue
                                                                        Requirements

                                                                        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.

                                                                        Alternate Namesextensions, user content, modifiers
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        370. Claim.procedure:other.sequence
                                                                        Definition

                                                                        A number to uniquely identify procedure entries.

                                                                        ShortProcedure instance identifier
                                                                        Control1..1
                                                                        TypepositiveInt
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summaryfalse
                                                                        Requirements

                                                                        Necessary to provide a mechanism to link to claim details.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        372. Claim.procedure:other.type
                                                                        Definition

                                                                        When the condition was observed or the relative ranking.

                                                                        ShortCategory of Procedure
                                                                        Comments

                                                                        For example: primary, secondary.

                                                                        Control1..1
                                                                        BindingThe codes SHALL be taken from PCT Procedure Type Value Set
                                                                        (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS)
                                                                        TypeCodeableConcept
                                                                        Is Modifierfalse
                                                                        Must Supporttrue
                                                                        Summaryfalse
                                                                        Requirements

                                                                        Often required to capture a particular diagnosis, for example: primary or discharge.

                                                                        Pattern Value{
                                                                          "coding" : [{
                                                                            "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                                                                            "code" : "other"
                                                                          }]
                                                                        }
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        374. Claim.procedure:other.date
                                                                        Definition

                                                                        Date and optionally time the procedure was performed.

                                                                        ShortWhen the procedure was performed
                                                                        Control0..1
                                                                        TypedateTime
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summaryfalse
                                                                        Requirements

                                                                        Required for auditing purposes.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        376. Claim.procedure:other.procedure[x]
                                                                        Definition

                                                                        The code or reference to a Procedure resource which identifies the clinical intervention performed.

                                                                        ShortSpecific clinical procedure
                                                                        Control1..1
                                                                        BindingThe codes SHALL be taken from PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
                                                                        (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes)
                                                                        TypeCodeableConcept
                                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Requirements

                                                                        This identifies the actual clinical procedure.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        378. Claim.procedure:other.udi
                                                                        Definition

                                                                        Unique Device Identifiers associated with this line item.

                                                                        ShortUnique device identifier
                                                                        Control0..*
                                                                        TypeReference(Device)
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Requirements

                                                                        The UDI code allows the insurer to obtain device level information on the product supplied.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        380. Claim.insurance
                                                                        Definition

                                                                        Financial instruments for reimbursement for the health care products and services specified on the claim.

                                                                        ShortPatient insurance information
                                                                        Comments

                                                                        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.

                                                                        Control1..*
                                                                        TypeBackboneElement
                                                                        Is Modifierfalse
                                                                        Summarytrue
                                                                        Requirements

                                                                        At least one insurer is required for a claim to be a claim.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        382. Claim.insurance.id
                                                                        Definition

                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                        ShortUnique id for inter-element referencing
                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        Summaryfalse
                                                                        384. Claim.insurance.extension
                                                                        Definition

                                                                        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.

                                                                        ShortAdditional content defined by implementations
                                                                        Comments

                                                                        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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Alternate Namesextensions, user content
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        386. Claim.insurance.modifierExtension
                                                                        Definition

                                                                        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).

                                                                        ShortExtensions that cannot be ignored even if unrecognized
                                                                        Comments

                                                                        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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                        Summarytrue
                                                                        Requirements

                                                                        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.

                                                                        Alternate Namesextensions, user content, modifiers
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        388. Claim.insurance.sequence
                                                                        Definition

                                                                        A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.

                                                                        ShortInsurance instance identifier
                                                                        Control1..1
                                                                        TypepositiveInt
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

                                                                        To maintain order of the coverages.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        390. Claim.insurance.focal
                                                                        Definition

                                                                        A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

                                                                        ShortCoverage to be used for adjudication
                                                                        Comments

                                                                        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.

                                                                        Control1..1
                                                                        Typeboolean
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

                                                                        To identify which coverage in the list is being used to adjudicate this claim.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        392. Claim.insurance.identifier
                                                                        Definition

                                                                        The business identifier to be used when the claim is sent for adjudication against this insurance policy.

                                                                        ShortPre-assigned Claim number
                                                                        Comments

                                                                        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'.

                                                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                        Control0..1
                                                                        TypeIdentifier
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Requirements

                                                                        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.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        394. Claim.insurance.coverage
                                                                        Definition

                                                                        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.

                                                                        ShortInsurance information
                                                                        Control1..1
                                                                        TypeReference(PCT Coverage)
                                                                        Is Modifierfalse
                                                                        Summarytrue
                                                                        Requirements

                                                                        Required to allow the adjudicator to locate the correct policy and history within their information system.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        396. Claim.insurance.coverage.id
                                                                        Definition

                                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                        ShortUnique id for inter-element referencing
                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        Summaryfalse
                                                                        398. Claim.insurance.coverage.extension
                                                                        Definition

                                                                        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.

                                                                        ShortAdditional content defined by implementations
                                                                        Comments

                                                                        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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Alternate Namesextensions, user content
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        SlicingThis element introduces a set of slices on Claim.insurance.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 400. Claim.insurance.coverage.extension:dataAbsentReason
                                                                          Slice NamedataAbsentReason
                                                                          Definition

                                                                          Provides a reason why the expected value or elements in the element that is extended are missing.

                                                                          ShortCoverage may be not applicable if estimate is for self-pay or uninsured
                                                                          Control0..1
                                                                          TypeExtension(Data Absent Reason) (Extension Type: code)
                                                                          Is Modifierfalse
                                                                          Must Supporttrue
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          402. Claim.insurance.coverage.reference
                                                                          Definition

                                                                          A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                                          ShortLiteral reference, Relative, internal or absolute URL
                                                                          Comments

                                                                          Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                                          Control0..1
                                                                          This element is affected by the following invariants: ref-1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summarytrue
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          404. Claim.insurance.coverage.type
                                                                          Definition

                                                                          The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                                          The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                                          ShortType the reference refers to (e.g. "Patient")
                                                                          Comments

                                                                          This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                                          Control0..1
                                                                          BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                          (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                                                          Aa resource (or, for logical models, the URI of the logical model).

                                                                          Typeuri
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summarytrue
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          406. Claim.insurance.coverage.identifier
                                                                          Definition

                                                                          An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                                          ShortLogical reference, when literal reference is not known
                                                                          Comments

                                                                          When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                                          When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                                          Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                                          Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                                          NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                          Control0..1
                                                                          TypeIdentifier
                                                                          Is Modifierfalse
                                                                          Summarytrue
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          408. Claim.insurance.coverage.display
                                                                          Definition

                                                                          Plain text narrative that identifies the resource in addition to the resource reference.

                                                                          ShortText alternative for the resource
                                                                          Comments

                                                                          This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summarytrue
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          410. Claim.insurance.businessArrangement
                                                                          Definition

                                                                          A business agreement number established between the provider and the insurer for special business processing purposes.

                                                                          ShortAdditional provider contract number
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          412. Claim.insurance.preAuthRef
                                                                          Definition

                                                                          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.

                                                                          ShortPrior authorization reference number
                                                                          Comments

                                                                          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.

                                                                          Control0..2
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          414. Claim.insurance.claimResponse
                                                                          Definition

                                                                          The result of the adjudication of the line items for the Coverage specified in this insurance.

                                                                          ShortAdjudication results
                                                                          Comments

                                                                          Must not be specified when 'focal=true' for this insurance.

                                                                          Control0..1
                                                                          TypeReference(ClaimResponse)
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Requirements

                                                                          An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          416. Claim.accident
                                                                          Definition

                                                                          Details of an accident which resulted in injuries which required the products and services listed in the claim.

                                                                          ShortDetails of the event
                                                                          Control0..1
                                                                          TypeBackboneElement
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Requirements

                                                                          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.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          418. Claim.accident.id
                                                                          Definition

                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                          ShortUnique id for inter-element referencing
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Summaryfalse
                                                                          420. Claim.accident.extension
                                                                          Definition

                                                                          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.

                                                                          ShortAdditional content defined by implementations
                                                                          Comments

                                                                          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.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Alternate Namesextensions, user content
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          422. Claim.accident.modifierExtension
                                                                          Definition

                                                                          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).

                                                                          ShortExtensions that cannot be ignored even if unrecognized
                                                                          Comments

                                                                          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.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                          Summarytrue
                                                                          Requirements

                                                                          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.

                                                                          Alternate Namesextensions, user content, modifiers
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          424. Claim.accident.date
                                                                          Definition

                                                                          Date of an accident event related to the products and services contained in the claim.

                                                                          ShortWhen the incident occurred
                                                                          Comments

                                                                          The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.

                                                                          Control1..1
                                                                          Typedate
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Required for audit purposes and adjudication.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          426. Claim.accident.type
                                                                          Definition

                                                                          The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.

                                                                          ShortThe nature of the accident
                                                                          Control0..1
                                                                          BindingUnless not suitable, these codes SHALL be taken from ActIncidentCode
                                                                          (extensible to http://terminology.hl7.org/ValueSet/v3-ActIncidentCode)

                                                                          Type of accident: work place, auto, etc.

                                                                          TypeCodeableConcept
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Coverage may be dependant on the type of accident.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          428. Claim.accident.location[x]
                                                                          Definition

                                                                          The physical location of the accident event.

                                                                          ShortWhere the event occurred
                                                                          Control0..1
                                                                          TypeAddress
                                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Required for audit purposes and determination of applicable insurance liability.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          430. Claim.accident.location[x].id
                                                                          Definition

                                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                          ShortUnique id for inter-element referencing
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Summaryfalse
                                                                          432. Claim.accident.location[x].extension
                                                                          Definition

                                                                          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.

                                                                          ShortAdditional content defined by implementations
                                                                          Comments

                                                                          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.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Alternate Namesextensions, user content
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          SlicingThis element introduces a set of slices on Claim.accident.location[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ url
                                                                          • 434. Claim.accident.location[x].use
                                                                            Definition

                                                                            The purpose of this address.

                                                                            Shorthome | work | temp | old | billing - purpose of this address
                                                                            Comments

                                                                            Applications can assume that an address is current unless it explicitly says that it is temporary or old.

                                                                            Control0..1
                                                                            BindingThe codes SHALL be taken from AddressUse
                                                                            (required to http://hl7.org/fhir/ValueSet/address-use|4.0.1)

                                                                            The use of an address.

                                                                            Typecode
                                                                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary or old address etc.for a current/permanent one
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

                                                                            Allows an appropriate address to be chosen from a list of many.

                                                                            Example<br/><b>General</b>:home
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            436. Claim.accident.location[x].type
                                                                            Definition

                                                                            Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

                                                                            Shortpostal | physical | both
                                                                            Comments

                                                                            The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

                                                                            Control0..1
                                                                            BindingThe codes SHALL be taken from AddressType
                                                                            (required to http://hl7.org/fhir/ValueSet/address-type|4.0.1)

                                                                            The type of an address (physical / postal).

                                                                            Typecode
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Example<br/><b>General</b>:both
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            438. Claim.accident.location[x].text
                                                                            Definition

                                                                            Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.

                                                                            ShortText representation of the address
                                                                            Comments

                                                                            Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

                                                                            A renderable, unencoded form.

                                                                            Example<br/><b>General</b>:137 Nowhere Street, Erewhon 9132
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            440. Claim.accident.location[x].line
                                                                            Definition

                                                                            This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

                                                                            ShortStreet name, number, direction & P.O. Box etc.
                                                                            Control0..*
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Example<br/><b>General</b>:137 Nowhere Street
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            442. Claim.accident.location[x].city
                                                                            Definition

                                                                            The name of the city, town, suburb, village or other community or delivery center.

                                                                            ShortName of city, town etc.
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Alternate NamesMunicpality
                                                                            Example<br/><b>General</b>:Erewhon
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            444. Claim.accident.location[x].district
                                                                            Definition

                                                                            The name of the administrative area (county).

                                                                            ShortDistrict name (aka county)
                                                                            Comments

                                                                            District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Alternate NamesCounty
                                                                            Example<br/><b>General</b>:Madison
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            446. Claim.accident.location[x].state
                                                                            Definition

                                                                            Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

                                                                            ShortSub-unit of country (abbreviations ok)
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Alternate NamesProvince, Territory
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            448. Claim.accident.location[x].postalCode
                                                                            Definition

                                                                            A postal code designating a region defined by the postal service.

                                                                            ShortPostal code for area
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Alternate NamesZip
                                                                            Example<br/><b>General</b>:9132
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            450. Claim.accident.location[x].country
                                                                            Definition

                                                                            Country - a nation as commonly understood or generally accepted.

                                                                            ShortCountry (e.g. can be ISO 3166 2 or 3 letter code)
                                                                            Comments

                                                                            ISO 3166 3 letter codes can be used in place of a human readable country name.

                                                                            Control0..1
                                                                            BindingThe codes SHALL be taken from Iso3166-1-2
                                                                            (required to http://hl7.org/fhir/ValueSet/iso3166-1-2)
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            452. Claim.accident.location[x].period
                                                                            Definition

                                                                            Time period when address was/is in use.

                                                                            ShortTime period when address was/is in use
                                                                            Control0..1
                                                                            TypePeriod
                                                                            Is Modifierfalse
                                                                            Summarytrue
                                                                            Requirements

                                                                            Allows addresses to be placed in historical context.

                                                                            Example<br/><b>General</b>:{ "start" : "2010-03-23", "end" : "2010-07-01" }
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            454. Claim.item
                                                                            Definition

                                                                            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.

                                                                            ShortProduct or service provided
                                                                            Control1..50
                                                                            TypeBackboneElement
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Requirements

                                                                            The items to be processed for adjudication.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            456. Claim.item.id
                                                                            Definition

                                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                            ShortUnique id for inter-element referencing
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                            Summaryfalse
                                                                            458. Claim.item.extension
                                                                            Definition

                                                                            An Extension

                                                                            ShortExtension
                                                                            Control1..*
                                                                            TypeExtension
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            SlicingThis element introduces a set of slices on Claim.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                            • value @ url
                                                                            • 460. Claim.item.extension:referralNumber
                                                                              Slice NamereferralNumber
                                                                              Definition

                                                                              This extension is used to provide the Referral Number.

                                                                              ShortReferral Number
                                                                              Control0..11
                                                                              This element is affected by the following invariants: ele-1
                                                                              TypeExtension(ReferralNumber) (Extension Type: string)
                                                                              Is Modifierfalse
                                                                              Must Supporttrue
                                                                              Summaryfalse
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              462. Claim.item.extension:gfeBillingProviderLineItemCtrlNum
                                                                              Slice NamegfeBillingProviderLineItemCtrlNum
                                                                              Definition

                                                                              This extension is used by the provider to assign a unique identifier to this item. The intent of this element is to allow the provider to assign something other than 'line number' for their purposes (e.g. tracking and troubleshooting).

                                                                              ShortExtension
                                                                              Control0..1
                                                                              This element is affected by the following invariants: ele-1
                                                                              TypeExtension(GFEBillingProviderLineItemCtrlNum) (Extension Type: Identifier)
                                                                              Is Modifierfalse
                                                                              Must Supporttrue
                                                                              Summaryfalse
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              464. Claim.item.extension:serviceDescription
                                                                              Slice NameserviceDescription
                                                                              Definition

                                                                              This extension is used to communicate a plain language description of the procedure, product, or service.

                                                                              ShortService Description
                                                                              Control1..1
                                                                              This element is affected by the following invariants: ele-1
                                                                              TypeExtension(Service Description) (Extension Type: string)
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              466. Claim.item.extension:ProviderEventMethodology
                                                                              Slice NameProviderEventMethodology
                                                                              Definition

                                                                              This extension is used for indicating the method a provider used to group services, and those providing such services, beyond what may be indicated through DRGs that the payer or patient may find helpful (e.g. grouping services by a standardized episode of care definition). This is provider generated text and should not be modified by the payer.

                                                                              ShortProvider Event Methodology
                                                                              Comments

                                                                              The method a provider used to group services. The extension definition contains additional detail.

                                                                              Control0..1
                                                                              This element is affected by the following invariants: ele-1
                                                                              TypeExtension(ProviderEventMethodology) (Extension Type: string)
                                                                              Is Modifierfalse
                                                                              Must Supporttrue
                                                                              Summaryfalse
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              468. Claim.item.modifierExtension
                                                                              Definition

                                                                              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).

                                                                              ShortExtensions that cannot be ignored even if unrecognized
                                                                              Comments

                                                                              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.

                                                                              Control0..*
                                                                              TypeExtension
                                                                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                              Summarytrue
                                                                              Requirements

                                                                              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.

                                                                              Alternate Namesextensions, user content, modifiers
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              470. Claim.item.sequence
                                                                              Definition

                                                                              A number to uniquely identify item entries.

                                                                              ShortItem instance identifier
                                                                              Control1..1
                                                                              TypepositiveInt
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summaryfalse
                                                                              Requirements

                                                                              Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              472. Claim.item.careTeamSequence
                                                                              Definition

                                                                              CareTeam members related to this service or product.

                                                                              ShortApplicable careTeam members
                                                                              Control0..*
                                                                              TypepositiveInt
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Must Supporttrue
                                                                              Summaryfalse
                                                                              Requirements

                                                                              Need to identify the individuals and their roles in the provision of the product or service.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              474. Claim.item.diagnosisSequence
                                                                              Definition

                                                                              Diagnosis applicable for this service or product.

                                                                              ShortApplicable diagnoses
                                                                              Control0..*
                                                                              TypepositiveInt
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summaryfalse
                                                                              Requirements

                                                                              Need to related the product or service to the associated diagnoses.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              476. Claim.item.procedureSequence
                                                                              Definition

                                                                              Procedures applicable for this service or product.

                                                                              ShortApplicable procedures
                                                                              Control0..*
                                                                              TypepositiveInt
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summaryfalse
                                                                              Requirements

                                                                              Need to provide any listed specific procedures to support the product or service being claimed.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              478. Claim.item.informationSequence
                                                                              Definition

                                                                              Exceptions, special conditions and supporting information applicable for this service or product.

                                                                              ShortApplicable exception and supporting information
                                                                              Control0..*
                                                                              TypepositiveInt
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summaryfalse
                                                                              Requirements

                                                                              Need to reference the supporting information items that relate directly to this product or service.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              480. Claim.item.revenue
                                                                              Definition

                                                                              The type of revenue or cost center providing the product and/or service.

                                                                              ShortRevenue or cost center code
                                                                              Control0..1
                                                                              BindingFor example codes, see ExampleRevenueCenterCodes
                                                                              (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                                                              Codes for the revenue or cost centers supplying the service and/or products.

                                                                              TypeCodeableConcept
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              Requirements

                                                                              Needed in the processing of institutional claims.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              482. Claim.item.category
                                                                              Definition

                                                                              Code to identify the general type of benefits under which products and services are provided.

                                                                              ShortBenefit classification
                                                                              Comments

                                                                              Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                                                              Control0..1
                                                                              BindingFor example codes, see BenefitCategoryCodes
                                                                              (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                                                              Benefit categories such as: oral-basic, major, glasses.

                                                                              TypeCodeableConcept
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              Requirements

                                                                              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.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              484. Claim.item.productOrService
                                                                              Definition

                                                                              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.

                                                                              ShortBilling, service, product, or drug code
                                                                              Comments

                                                                              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'.

                                                                              Control1..1
                                                                              BindingThe codes SHALL be taken from Claim Medical Product or Service Value Set
                                                                              (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes)
                                                                              TypeCodeableConcept
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              Requirements

                                                                              Necessary to state what was provided or done.

                                                                              Alternate NamesDrug Code, Bill Code, Service Code
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              486. Claim.item.productOrService.id
                                                                              Definition

                                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                              ShortUnique id for inter-element referencing
                                                                              Control0..1
                                                                              Typestring
                                                                              Is Modifierfalse
                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                              Summaryfalse
                                                                              488. Claim.item.productOrService.extension
                                                                              Definition

                                                                              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.

                                                                              ShortAdditional content defined by implementations
                                                                              Comments

                                                                              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.

                                                                              Control0..*
                                                                              TypeExtension
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              Alternate Namesextensions, user content
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              SlicingThis element introduces a set of slices on Claim.item.productOrService.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 490. Claim.item.productOrService.coding
                                                                                Definition

                                                                                A reference to a code defined by a terminology system.

                                                                                ShortCode defined by a terminology system
                                                                                Comments

                                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                Control0..*
                                                                                TypeCoding
                                                                                Is Modifierfalse
                                                                                Summarytrue
                                                                                Requirements

                                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                pct-cpt-display: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) (system = 'http://www.ama-assn.org/go/cpt' implies display.exists())
                                                                                492. Claim.item.productOrService.text
                                                                                Definition

                                                                                A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                ShortPlain text representation of the concept
                                                                                Comments

                                                                                Very often the text is the same as a displayName of one of the codings.

                                                                                Control0..1
                                                                                Typestring
                                                                                Is Modifierfalse
                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                Summarytrue
                                                                                Requirements

                                                                                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                494. Claim.item.modifier
                                                                                Definition

                                                                                Item typification or modifiers codes to convey additional context for the product or service.

                                                                                ShortProduct or service billing modifiers
                                                                                Comments

                                                                                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.

                                                                                Control0..4
                                                                                BindingThe codes SHALL be taken from PCT GFE Item CPT - HCPCS Value Set
                                                                                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS)
                                                                                TypeCodeableConcept
                                                                                Is Modifierfalse
                                                                                Must Supporttrue
                                                                                Summaryfalse
                                                                                Requirements

                                                                                To support inclusion of the item for adjudication or to charge an elevated fee.

                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                496. Claim.item.modifier.id
                                                                                Definition

                                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                ShortUnique id for inter-element referencing
                                                                                Control0..1
                                                                                Typestring
                                                                                Is Modifierfalse
                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                Summaryfalse
                                                                                498. Claim.item.modifier.extension
                                                                                Definition

                                                                                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.

                                                                                ShortAdditional content defined by implementations
                                                                                Comments

                                                                                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.

                                                                                Control0..*
                                                                                TypeExtension
                                                                                Is Modifierfalse
                                                                                Summaryfalse
                                                                                Alternate Namesextensions, user content
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                SlicingThis element introduces a set of slices on Claim.item.modifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                • value @ url
                                                                                • 500. Claim.item.modifier.coding
                                                                                  Definition

                                                                                  A reference to a code defined by a terminology system.

                                                                                  ShortCode defined by a terminology system
                                                                                  Comments

                                                                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                                  Control0..*
                                                                                  TypeCoding
                                                                                  Is Modifierfalse
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  pct-cpt-display: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) (system = 'http://www.ama-assn.org/go/cpt' implies display.exists())
                                                                                  502. Claim.item.modifier.text
                                                                                  Definition

                                                                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                                                  ShortPlain text representation of the concept
                                                                                  Comments

                                                                                  Very often the text is the same as a displayName of one of the codings.

                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  504. Claim.item.programCode
                                                                                  Definition

                                                                                  Identifies the program under which this may be recovered.

                                                                                  ShortProgram the product or service is provided under
                                                                                  Comments

                                                                                  For example: Neonatal program, child dental program or drug users recovery program.

                                                                                  Control0..*
                                                                                  BindingFor example codes, see ExampleProgramReasonCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                                                                  Program specific reason codes.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  506. Claim.item.serviced[x]
                                                                                  Definition

                                                                                  This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication

                                                                                  ShortThis is the planned or estimated date(s)s of service
                                                                                  Control1..1
                                                                                  TypeChoice of: date, Period
                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Must Supporttrue
                                                                                  Must Support TypesNo must-support rules about the choice of types/profiles
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Needed to determine whether the service or product was provided during the term of the insurance coverage.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  508. Claim.item.location[x]
                                                                                  Definition

                                                                                  Where the product or service was provided.

                                                                                  ShortPlace of service or where product was supplied
                                                                                  Control1..1
                                                                                  BindingThe codes SHALL be taken from PCT GFE CMS Place of Service Value Set
                                                                                  (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFECMSPOS)
                                                                                  TypeCodeableConcept
                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  510. Claim.item.quantity
                                                                                  Definition

                                                                                  The number of repetitions of a service or product.

                                                                                  ShortCount of products or services
                                                                                  Control1..1
                                                                                  TypeQuantity(SimpleQuantity)
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Required when the product or service code does not convey the quantity provided.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  512. Claim.item.unitPrice
                                                                                  Definition

                                                                                  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.

                                                                                  ShortFee, charge or cost per item
                                                                                  Control1..1
                                                                                  TypeMoney
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The amount charged to the patient by the provider for a single unit.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  514. Claim.item.factor
                                                                                  Definition

                                                                                  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.

                                                                                  ShortPrice scaling factor
                                                                                  Comments

                                                                                  To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                                                                  Control0..1
                                                                                  Typedecimal
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  516. Claim.item.net
                                                                                  Definition

                                                                                  The quantity times the unit price for an additional service or product or charge.

                                                                                  ShortTotal charge amount for the service line
                                                                                  Comments

                                                                                  For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                                                                  Control1..1
                                                                                  TypeMoney
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Provides the total amount claimed for the group (if a grouper) or the line item.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  518. Claim.item.udi
                                                                                  Definition

                                                                                  Unique Device Identifiers associated with this line item.

                                                                                  ShortUnique device identifier
                                                                                  Control0..*
                                                                                  TypeReference(Device)
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The UDI code allows the insurer to obtain device level information on the product supplied.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  520. Claim.item.bodySite
                                                                                  Definition

                                                                                  Physical service site on the patient (limb, tooth, etc.).

                                                                                  ShortAnatomical location
                                                                                  Comments

                                                                                  For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

                                                                                  Control0..1
                                                                                  BindingFor example codes, see OralSiteCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/tooth)

                                                                                  The code for the teeth, quadrant, sextant and arch.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Allows insurer to validate specific procedures.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  522. Claim.item.subSite
                                                                                  Definition

                                                                                  A region or surface of the bodySite, e.g. limb region or tooth surface(s).

                                                                                  ShortAnatomical sub-location
                                                                                  Control0..*
                                                                                  BindingFor example codes, see SurfaceCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/surface)

                                                                                  The code for the tooth surface and surface combinations.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Allows insurer to validate specific procedures.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  524. Claim.item.encounter
                                                                                  Definition

                                                                                  The Encounters during which this Claim was created or to which the creation of this record is tightly associated.

                                                                                  ShortEncounters related to this billed item
                                                                                  Comments

                                                                                  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.

                                                                                  Control0..*
                                                                                  TypeReference(Encounter)
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Used in some jurisdictions to link clinical events to claim items.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  526. Claim.item.detail
                                                                                  Definition

                                                                                  A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                                                                                  ShortDrug Identification Information
                                                                                  Control0..*
                                                                                  TypeBackboneElement
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The items to be processed for adjudication.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  528. Claim.item.detail.id
                                                                                  Definition

                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                  ShortUnique id for inter-element referencing
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  Summaryfalse
                                                                                  530. Claim.item.detail.extension
                                                                                  Definition

                                                                                  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.

                                                                                  ShortAdditional content defined by implementations
                                                                                  Comments

                                                                                  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.

                                                                                  Control0..*
                                                                                  TypeExtension
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Alternate Namesextensions, user content
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                  532. Claim.item.detail.modifierExtension
                                                                                  Definition

                                                                                  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).

                                                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                                                  Comments

                                                                                  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.

                                                                                  Control0..*
                                                                                  TypeExtension
                                                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  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.

                                                                                  Alternate Namesextensions, user content, modifiers
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                  534. Claim.item.detail.sequence
                                                                                  Definition

                                                                                  A number to uniquely identify item entries.

                                                                                  ShortItem instance identifier
                                                                                  Control1..1
                                                                                  TypepositiveInt
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  536. Claim.item.detail.revenue
                                                                                  Definition

                                                                                  The type of revenue or cost center providing the product and/or service.

                                                                                  ShortRevenue or cost center code
                                                                                  Control0..1
                                                                                  BindingFor example codes, see ExampleRevenueCenterCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                                                                  Codes for the revenue or cost centers supplying the service and/or products.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Needed in the processing of institutional claims.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  538. Claim.item.detail.category
                                                                                  Definition

                                                                                  Code to identify the general type of benefits under which products and services are provided.

                                                                                  ShortBenefit classification
                                                                                  Comments

                                                                                  Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                                                                  Control0..1
                                                                                  BindingFor example codes, see BenefitCategoryCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                                                                  Benefit categories such as: oral-basic, major, glasses.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  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.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  540. Claim.item.detail.productOrService
                                                                                  Definition

                                                                                  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.

                                                                                  ShortBilling, service, product, or drug code
                                                                                  Comments

                                                                                  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'.

                                                                                  Control1..1
                                                                                  BindingThe codes SHALL be taken from Claim Medical Product or Service Value Set
                                                                                  (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes)
                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Necessary to state what was provided or done.

                                                                                  Alternate NamesDrug Code, Bill Code, Service Code
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  542. Claim.item.detail.modifier
                                                                                  Definition

                                                                                  Item typification or modifiers codes to convey additional context for the product or service.

                                                                                  ShortService/Product billing modifiers
                                                                                  Comments

                                                                                  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.

                                                                                  Control0..*
                                                                                  BindingFor example codes, see ModifierTypeCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                                                                  Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  To support inclusion of the item for adjudication or to charge an elevated fee.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  544. Claim.item.detail.programCode
                                                                                  Definition

                                                                                  Identifies the program under which this may be recovered.

                                                                                  ShortProgram the product or service is provided under
                                                                                  Comments

                                                                                  For example: Neonatal program, child dental program or drug users recovery program.

                                                                                  Control0..*
                                                                                  BindingFor example codes, see ExampleProgramReasonCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                                                                  Program specific reason codes.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  546. Claim.item.detail.quantity
                                                                                  Definition

                                                                                  The number of repetitions of a service or product.

                                                                                  ShortCount of products or services
                                                                                  Control0..1
                                                                                  TypeQuantity(SimpleQuantity)
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Required when the product or service code does not convey the quantity provided.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  548. Claim.item.detail.unitPrice
                                                                                  Definition

                                                                                  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.

                                                                                  ShortFee, charge or cost per item
                                                                                  Control0..1
                                                                                  TypeMoney
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The amount charged to the patient by the provider for a single unit.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  550. Claim.item.detail.factor
                                                                                  Definition

                                                                                  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.

                                                                                  ShortPrice scaling factor
                                                                                  Comments

                                                                                  To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                                                                  Control0..1
                                                                                  Typedecimal
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  552. Claim.item.detail.net
                                                                                  Definition

                                                                                  The quantity times the unit price for an additional service or product or charge.

                                                                                  ShortTotal item cost
                                                                                  Comments

                                                                                  For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                                                                  Control0..1
                                                                                  TypeMoney
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Provides the total amount claimed for the group (if a grouper) or the line item.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  554. Claim.item.detail.udi
                                                                                  Definition

                                                                                  Unique Device Identifiers associated with this line item.

                                                                                  ShortUnique device identifier
                                                                                  Control0..*
                                                                                  TypeReference(Device)
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The UDI code allows the insurer to obtain device level information on the product supplied.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  556. Claim.item.detail.subDetail
                                                                                  Definition

                                                                                  A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                                                                                  ShortProduct or service provided
                                                                                  Control0..*
                                                                                  TypeBackboneElement
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The items to be processed for adjudication.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  558. Claim.item.detail.subDetail.id
                                                                                  Definition

                                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                                  ShortUnique id for inter-element referencing
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  Summaryfalse
                                                                                  560. Claim.item.detail.subDetail.extension
                                                                                  Definition

                                                                                  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.

                                                                                  ShortAdditional content defined by implementations
                                                                                  Comments

                                                                                  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.

                                                                                  Control0..*
                                                                                  TypeExtension
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Alternate Namesextensions, user content
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                  562. Claim.item.detail.subDetail.modifierExtension
                                                                                  Definition

                                                                                  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).

                                                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                                                  Comments

                                                                                  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.

                                                                                  Control0..*
                                                                                  TypeExtension
                                                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                  Summarytrue
                                                                                  Requirements

                                                                                  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.

                                                                                  Alternate Namesextensions, user content, modifiers
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                  564. Claim.item.detail.subDetail.sequence
                                                                                  Definition

                                                                                  A number to uniquely identify item entries.

                                                                                  ShortItem instance identifier
                                                                                  Control1..1
                                                                                  TypepositiveInt
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  566. Claim.item.detail.subDetail.revenue
                                                                                  Definition

                                                                                  The type of revenue or cost center providing the product and/or service.

                                                                                  ShortRevenue or cost center code
                                                                                  Control0..1
                                                                                  BindingFor example codes, see ExampleRevenueCenterCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                                                                  Codes for the revenue or cost centers supplying the service and/or products.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Needed in the processing of institutional claims.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  568. Claim.item.detail.subDetail.category
                                                                                  Definition

                                                                                  Code to identify the general type of benefits under which products and services are provided.

                                                                                  ShortBenefit classification
                                                                                  Comments

                                                                                  Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                                                                  Control0..1
                                                                                  BindingFor example codes, see BenefitCategoryCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                                                                  Benefit categories such as: oral-basic, major, glasses.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  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.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  570. Claim.item.detail.subDetail.productOrService
                                                                                  Definition

                                                                                  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.

                                                                                  ShortBilling, service, product, or drug code
                                                                                  Comments

                                                                                  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'.

                                                                                  Control1..1
                                                                                  BindingFor example codes, see USCLSCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                                                                  Allowable service and product codes.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Necessary to state what was provided or done.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  572. Claim.item.detail.subDetail.modifier
                                                                                  Definition

                                                                                  Item typification or modifiers codes to convey additional context for the product or service.

                                                                                  ShortService/Product billing modifiers
                                                                                  Comments

                                                                                  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.

                                                                                  Control0..*
                                                                                  BindingFor example codes, see ModifierTypeCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                                                                  Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  To support inclusion of the item for adjudication or to charge an elevated fee.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  574. Claim.item.detail.subDetail.programCode
                                                                                  Definition

                                                                                  Identifies the program under which this may be recovered.

                                                                                  ShortProgram the product or service is provided under
                                                                                  Comments

                                                                                  For example: Neonatal program, child dental program or drug users recovery program.

                                                                                  Control0..*
                                                                                  BindingFor example codes, see ExampleProgramReasonCodes
                                                                                  (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                                                                  Program specific reason codes.

                                                                                  TypeCodeableConcept
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  576. Claim.item.detail.subDetail.quantity
                                                                                  Definition

                                                                                  The number of repetitions of a service or product.

                                                                                  ShortCount of products or services
                                                                                  Control0..1
                                                                                  TypeQuantity(SimpleQuantity)
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Required when the product or service code does not convey the quantity provided.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  578. Claim.item.detail.subDetail.unitPrice
                                                                                  Definition

                                                                                  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.

                                                                                  ShortFee, charge or cost per item
                                                                                  Control0..1
                                                                                  TypeMoney
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The amount charged to the patient by the provider for a single unit.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  580. Claim.item.detail.subDetail.factor
                                                                                  Definition

                                                                                  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.

                                                                                  ShortPrice scaling factor
                                                                                  Comments

                                                                                  To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                                                                  Control0..1
                                                                                  Typedecimal
                                                                                  Is Modifierfalse
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  582. Claim.item.detail.subDetail.net
                                                                                  Definition

                                                                                  The quantity times the unit price for an additional service or product or charge.

                                                                                  ShortTotal item cost
                                                                                  Comments

                                                                                  For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                                                                  Control0..1
                                                                                  TypeMoney
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Provides the total amount claimed for the group (if a grouper) or the line item.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  584. Claim.item.detail.subDetail.udi
                                                                                  Definition

                                                                                  Unique Device Identifiers associated with this line item.

                                                                                  ShortUnique device identifier
                                                                                  Control0..*
                                                                                  TypeReference(Device)
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The UDI code allows the insurer to obtain device level information on the product supplied.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  586. Claim.total
                                                                                  Definition

                                                                                  The total value of the all the items in the claim.

                                                                                  ShortTotal GFE Charges Submitted
                                                                                  Control1..1
                                                                                  TypeMoney
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  Used for control total purposes.

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))