Patient Cost Transparency Implementation Guide
2.0.0 - 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 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: PCTGFESummary - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the davinci-pct-gfe-summary 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: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 estimate, e.g. application of sliding scale for self-pay/uninsured patients
    Comments

    These disclaimers may include, but are not limited to things such as: provider discounts (e.g. application of sliding fee scale), 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())
    8. Claim.extension:serviceDescription
    Slice NameserviceDescription
    Definition

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

    ShortService Description
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Service Description) (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.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())
    12. 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()))
    14. 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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse",
        "code" : "estimate-summary"
      }]
    }
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. 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..01
    BindingFor example codes, see ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtype
    (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()))
    18. 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()))
    20. 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(US Core Patient Profile, 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()))
    22. Claim.billablePeriod
    Definition

    The period for which charges are being submitted.

    ShortThe full Period of Care for all services or products included in the estimate from the first event to the last event.Relevant 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
    Must Supporttrue
    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()))
    24. 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()))
    26. Claim.enterer
    Definition

    Individual who created the claim, predetermination or preauthorization.

    ShortAuthor of the claim
    Control0..01
    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()))
    28. Claim.insurer
    Definition

    The Insurer who is target of the request.

    ShortTarget
    Control0..1
    TypeReference(PCT Organization, Organization)
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. Claim.provider
    Definition

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

    ShortParty 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(Practitioner, PractitionerRole, Organization)
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. 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
    • 34. Claim.provider.extension:dataAbsentReason
      Slice NamedataAbsentReason
      Definition

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

      Shortunknown | asked | temp | notasked | masked | unsupported | astext | error
      Control1..1
      TypeExtension(Data Absent Reason) (Extension Type: code)
      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())
      36. Claim.provider.extension:dataAbsentReason.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.

      Control0..0*
      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())
      ele-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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 38. Claim.provider.extension:dataAbsentReason.url
        Definition

        Source of the definition for the extension code - a logical name or a URL.

        Shortidentifies the meaning of the extension
        Comments

        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valuehttp://hl7.org/fhir/StructureDefinition/data-absent-reason
        40. Claim.provider.extension:dataAbsentReason.value[x]
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortValue of extension
        Control10..1
        This element is affected by the following invariants: ext-1
        BindingThe codes SHALL be taken from For codes, see DataAbsentReason
        (required to http://hl7.org/fhir/ValueSet/data-absent-reason)
        Typecode, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [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
        Pattern Valuenot-applicable
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. 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..01
        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()))
        44. 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..01
        BindingUnless not suitable, these codes SHALL be taken from ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types
        (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()))
        46. 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..01
        TypeIdentifier
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. 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..01
        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()))
        50. 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()))
        52. 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..01
        BindingFor example codes, see Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserve
        (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()))
        54. Claim.prescription
        Definition

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

        ShortPrescription authorizing services and products
        Control0..01
        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()))
        56. 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..01
        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()))
        58. 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..01
        TypeBackboneElement
        Is Modifierfalse
        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()))
        62. 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..01
        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()))
        64. Claim.facility
        Definition

        Facility where the services were provided.

        ShortServicing facility
        Control0..01
        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()))
        66. 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
        • 68. 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())
          70. 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()))
          72. 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()))
          74. 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()))
          76. 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()))
          78. Claim.careTeam:attending
          Slice Nameattending
          Definition

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

          ShortMembers of the care team
          Control0..1*
          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()))
          80. Claim.careTeam:attending.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())
          82. Claim.careTeam:attending.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()))
          84. Claim.careTeam:attending.provider
          Definition

          Member of the team who provided the product or service.

          ShortPractitioner or organization
          Control1..1
          TypeReference(PCT Practitioner, 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()))
          86. Claim.careTeam:attending.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",
              "version" : "1.0.1",
              "code" : "attending"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          88. Claim.careTeam:attending.qualification
          Definition

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

          ShortPractitioner credential or specialization
          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()))
          90. Claim.careTeam:operating
          Slice Nameoperating
          Definition

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

          ShortMembers of the care team
          Control0..2*
          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()))
          92. Claim.careTeam:operating.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())
          94. Claim.careTeam:operating.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()))
          96. Claim.careTeam:operating.provider
          Definition

          Member of the team who provided the product or service.

          ShortPractitioner or organization
          Control1..1
          TypeReference(PCT Practitioner, 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()))
          98. Claim.careTeam:operating.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",
              "version" : "1.0.1",
              "code" : "operating"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          100. Claim.careTeam:rendering
          Slice Namerendering
          Definition

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

          ShortMembers of the care team
          Control0..1*
          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()))
          102. 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())
          104. 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()))
          106. Claim.careTeam:rendering.provider
          Definition

          Member of the team who provided the product or service.

          ShortPractitioner or organization
          Control1..1
          TypeReference(PCT Practitioner, 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()))
          108. 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",
              "version" : "1.0.1",
              "code" : "rendering"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          110. 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
          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()))
          112. 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())
          114. 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()))
          116. 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()))
          118. 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",
              "version" : "1.0.1",
              "code" : "referring"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          120. 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..0*
          TypeBackboneElement
          Is Modifierfalse
          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()))
          125. 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
          • 127. 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())
            129. 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()))
            131. 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()))
            133. 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 Diagnosis Type Codeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
            (required to http://terminology.hl7.org/ValueSet/diagnosistype)
            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()))
            135. 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()))
            137. 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())
            139. 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()))
            141. 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()))
            143. 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 Diagnosis Type Codeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
            (required to http://terminology.hl7.org/ValueSet/diagnosistype)
            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/diagnosistype",
                "code" : "principal"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            145. Claim.diagnosis:admitting
            Slice Nameadmitting
            Definition

            Information about diagnoses relevant to the claim items.

            ShortPertinent diagnosis information
            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()))
            147. Claim.diagnosis:admitting.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())
            149. Claim.diagnosis:admitting.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()))
            151. Claim.diagnosis:admitting.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()))
            153. Claim.diagnosis:admitting.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 Diagnosis Type Codeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
            (required to http://terminology.hl7.org/ValueSet/diagnosistype)
            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/diagnosistype",
                "code" : "admitting"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            155. Claim.diagnosis:patientReasonForVisit
            Slice NamepatientReasonForVisit
            Definition

            Information about diagnoses relevant to the claim items.

            ShortPertinent diagnosis information
            Control0..3*
            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()))
            157. Claim.diagnosis:patientReasonForVisit.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())
            159. Claim.diagnosis:patientReasonForVisit.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()))
            161. Claim.diagnosis:patientReasonForVisit.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()))
            163. Claim.diagnosis:patientReasonForVisit.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 Diagnosis Type Codeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
            (required to http://terminology.hl7.org/ValueSet/diagnosistype)
            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/diagnosistype",
                "code" : "patientreasonforvisit"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            165. Claim.diagnosis:externalcauseofinjury
            Slice Nameexternalcauseofinjury
            Definition

            Information about diagnoses relevant to the claim items.

            ShortPertinent diagnosis information
            Control0..12*
            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()))
            167. Claim.diagnosis:externalcauseofinjury.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())
            169. Claim.diagnosis:externalcauseofinjury.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()))
            171. Claim.diagnosis:externalcauseofinjury.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()))
            173. Claim.diagnosis:externalcauseofinjury.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 Diagnosis Type Codeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
            (required to http://terminology.hl7.org/ValueSet/diagnosistype)
            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/diagnosistype",
                "code" : "externalcauseofinjury"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            175. Claim.diagnosis:other
            Slice Nameother
            Definition

            Information about diagnoses relevant to the claim items.

            ShortPertinent diagnosis information
            Control0..24*
            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()))
            177. 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())
            179. 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()))
            181. 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
            Must Supporttrue
            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()))
            183. 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 Diagnosis Type Codeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
            (required to http://terminology.hl7.org/ValueSet/diagnosistype)
            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/diagnosistype",
                "code" : "secondary"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            185. 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
            • 187. 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
              • 189. 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())
                191. 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())
                193. 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()))
                195. 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()))
                197. 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()))
                199. Claim.procedure:principal
                Slice Nameprincipal
                Definition

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

                ShortPrincipal clinical procedure performedClinical procedures performed
                Control0..1*
                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()))
                201. Claim.procedure:principal.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
                • 203. Claim.procedure:principal.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())
                  205. Claim.procedure: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())
                  207. Claim.procedure:principal.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.

                  Pattern Value1
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  209. Claim.procedure:principal.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" : "principal"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  211. Claim.procedure:principal.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 ICD-10 Procedure Codeshttp://hl7.org/fhir/ValueSet/icd-10-procedures
                  (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes)
                  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()))
                  213. 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()))
                  215. 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
                  • 217. 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())
                    219. 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())
                    221. 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()))
                    223. 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()))
                    225. 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()))
                    227. 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()))
                    229. 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
                    • 231. 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())
                      233. 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())
                      235. 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()))
                      237. 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()))
                      239. 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()))
                      241. 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()))
                      243. 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())
                      245. 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()))
                      247. 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()))
                      249. 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()))
                      251. 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..0*
                      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()))
                      253. 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
                      Control0..0*
                      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()))
                      258. Claim.total
                      Definition

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

                      ShortTotal GFE ChargesTotal 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: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 estimate, e.g. application of sliding scale for self-pay/uninsured patients
                        Comments

                        These disclaimers may include, but are not limited to things such as: provider discounts (e.g. application of sliding fee scale), 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
                        6. Claim.extension:serviceDescription
                        Slice NameserviceDescription
                        Control0..1
                        TypeExtension(Service Description) (Extension Type: string)
                        Must Supporttrue
                        8. Claim.type
                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse",
                            "code" : "estimate-summary"
                          }]
                        }
                        10. Claim.subType
                        Control0..0
                        12. Claim.use
                        Pattern Valuepredetermination
                        14. Claim.patient
                        TypeReference(US Core Patient Profile)
                        16. Claim.billablePeriod
                        ShortThe full Period of Care for all services or products included in the estimate from the first event to the last event.
                        Must Supporttrue
                        18. Claim.enterer
                        Control0..0
                        20. Claim.insurer
                        TypeReference(PCT Organization)
                        Must Supporttrue
                        22. Claim.provider
                        24. Claim.provider.extension
                        Control1..?
                        26. Claim.provider.extension:dataAbsentReason
                        Slice NamedataAbsentReason
                        Control1..1
                        TypeExtension(Data Absent Reason) (Extension Type: code)
                        28. Claim.provider.extension:dataAbsentReason.value[x]
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Pattern Valuenot-applicable
                        30. Claim.provider.reference
                        Control0..0
                        32. Claim.provider.type
                        Control0..0
                        34. Claim.provider.identifier
                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        Control0..0
                        36. Claim.provider.display
                        Control0..0
                        38. Claim.priority
                        BindingThe codes SHALL be taken from ProcessPriorityCodes
                        (required to http://hl7.org/fhir/ValueSet/process-priority)
                        40. Claim.fundsReserve
                        Control0..0
                        42. Claim.prescription
                        Control0..0
                        44. Claim.originalPrescription
                        Control0..0
                        46. Claim.payee
                        Control0..0
                        48. Claim.referral
                        Control0..0
                        50. Claim.facility
                        Control0..0
                        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:attending
                          Slice Nameattending
                          Control0..1
                          Must Supporttrue
                          62. Claim.careTeam:attending.provider
                          TypeReference(PCT Practitioner)
                          64. Claim.careTeam:attending.role
                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
                              "version" : "1.0.1",
                              "code" : "attending"
                            }]
                          }
                          66. Claim.careTeam:attending.qualification
                          Control1..?
                          68. Claim.careTeam:operating
                          Slice Nameoperating
                          Control0..2
                          Must Supporttrue
                          70. Claim.careTeam:operating.provider
                          TypeReference(PCT Practitioner)
                          72. Claim.careTeam:operating.role
                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
                              "version" : "1.0.1",
                              "code" : "operating"
                            }]
                          }
                          74. Claim.careTeam:rendering
                          Slice Namerendering
                          Control0..1
                          Must Supporttrue
                          76. Claim.careTeam:rendering.provider
                          TypeReference(PCT Practitioner)
                          78. Claim.careTeam:rendering.role
                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
                              "version" : "1.0.1",
                              "code" : "rendering"
                            }]
                          }
                          80. Claim.careTeam:referring
                          Slice Namereferring
                          Control0..1
                          Must Supporttrue
                          82. Claim.careTeam:referring.role
                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
                              "version" : "1.0.1",
                              "code" : "referring"
                            }]
                          }
                          84. Claim.supportingInfo
                          Control0..0
                          86. 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
                          • 88. Claim.diagnosis.type
                            BindingThe codes SHALL be taken from Diagnosis Type Codes
                            (required to http://terminology.hl7.org/ValueSet/diagnosistype)
                            Must Supporttrue
                            90. 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
                            92. Claim.diagnosis:principal.sequence
                            Pattern Value1
                            94. 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]
                            96. Claim.diagnosis:principal.type
                            Control1..1
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
                                "code" : "principal"
                              }]
                            }
                            98. Claim.diagnosis:admitting
                            Slice Nameadmitting
                            Control0..1
                            Must Supporttrue
                            100. Claim.diagnosis:admitting.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]
                            102. Claim.diagnosis:admitting.type
                            Control1..1
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
                                "code" : "admitting"
                              }]
                            }
                            104. Claim.diagnosis:patientReasonForVisit
                            Slice NamepatientReasonForVisit
                            Control0..3
                            Must Supporttrue
                            106. Claim.diagnosis:patientReasonForVisit.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]
                            108. Claim.diagnosis:patientReasonForVisit.type
                            Control1..1
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
                                "code" : "patientreasonforvisit"
                              }]
                            }
                            110. Claim.diagnosis:externalcauseofinjury
                            Slice Nameexternalcauseofinjury
                            Control0..12
                            Must Supporttrue
                            112. Claim.diagnosis:externalcauseofinjury.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]
                            114. Claim.diagnosis:externalcauseofinjury.type
                            Control1..1
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
                                "code" : "externalcauseofinjury"
                              }]
                            }
                            116. Claim.diagnosis:other
                            Slice Nameother
                            Control0..24
                            Must Supporttrue
                            118. 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]
                            Must Supporttrue
                            120. Claim.diagnosis:other.type
                            Control1..1
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
                                "code" : "secondary"
                              }]
                            }
                            122. 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
                            • 124. 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
                              • 126. Claim.procedure.extension:serviceDescription
                                Slice NameserviceDescription
                                Control1..1
                                TypeExtension(Service Description) (Extension Type: string)
                                128. 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
                                130. Claim.procedure:principal
                                Slice Nameprincipal
                                ShortPrincipal clinical procedure performed
                                Control0..1
                                Must Supporttrue
                                132. Claim.procedure:principal.extension:serviceDescription
                                Slice NameserviceDescription
                                Control1..1
                                TypeExtension(Service Description) (Extension Type: string)
                                134. Claim.procedure:principal.sequence
                                Pattern Value1
                                136. Claim.procedure:principal.type
                                Control1..1
                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                                    "code" : "principal"
                                  }]
                                }
                                138. Claim.procedure:principal.procedure[x]
                                BindingThe codes SHALL be taken from ICD-10 Procedure Codes
                                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes)
                                TypeCodeableConcept
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                140. Claim.procedure:anesthesiaRelated
                                Slice NameanesthesiaRelated
                                Control0..2
                                Must Supporttrue
                                142. Claim.procedure:anesthesiaRelated.extension:serviceDescription
                                Slice NameserviceDescription
                                Control1..1
                                TypeExtension(Service Description) (Extension Type: string)
                                144. Claim.procedure:anesthesiaRelated.type
                                Control1..1
                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                                    "code" : "procedureRequiringAnesthesia"
                                  }]
                                }
                                146. 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]
                                148. Claim.procedure:other
                                Slice Nameother
                                Control0..24
                                Must Supporttrue
                                150. Claim.procedure:other.extension:serviceDescription
                                Slice NameserviceDescription
                                Control1..1
                                TypeExtension(Service Description) (Extension Type: string)
                                152. Claim.procedure:other.type
                                Control1..1
                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                                    "code" : "other"
                                  }]
                                }
                                154. 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]
                                156. Claim.insurance
                                158. Claim.insurance.coverage
                                TypeReference(PCT Coverage)
                                160. Claim.insurance.preAuthRef
                                Control0..0
                                162. Claim.accident
                                164. Claim.accident.location[x]
                                TypeAddress, Reference(Location)
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                166. Claim.accident.location[x].country
                                BindingThe codes SHALL be taken from Iso3166-1-2
                                (required to http://hl7.org/fhir/ValueSet/iso3166-1-2)
                                168. Claim.item
                                Control0..0
                                170. Claim.total
                                ShortTotal GFE Charges
                                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
                                Control0..*
                                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: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 estimate, e.g. application of sliding scale for self-pay/uninsured patients
                                  Comments

                                  These disclaimers may include, but are not limited to things such as: provider discounts (e.g. application of sliding fee scale), 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())
                                  18. Claim.extension:serviceDescription
                                  Slice NameserviceDescription
                                  Definition

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

                                  ShortService Description
                                  Control0..1
                                  This element is affected by the following invariants: ele-1
                                  TypeExtension(Service Description) (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.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())
                                  22. 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)
                                  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()))
                                  24. 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()))
                                  26. 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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse",
                                      "code" : "estimate-summary"
                                    }]
                                  }
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  28. 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..0
                                  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()))
                                  30. 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()))
                                  32. 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(US Core Patient Profile)
                                  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()))
                                  34. Claim.billablePeriod
                                  Definition

                                  The period for which charges are being submitted.

                                  ShortThe full Period of Care for all services or products included in the estimate from the first event to the last event.
                                  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
                                  Must Supporttrue
                                  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()))
                                  36. 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()))
                                  38. Claim.enterer
                                  Definition

                                  Individual who created the claim, predetermination or preauthorization.

                                  ShortAuthor of the claim
                                  Control0..0
                                  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()))
                                  40. Claim.insurer
                                  Definition

                                  The Insurer who is target of the request.

                                  ShortTarget
                                  Control0..1
                                  TypeReference(PCT Organization)
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  42. Claim.provider
                                  Definition

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

                                  ShortParty 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(Practitioner, PractitionerRole, Organization)
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  44. 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
                                  46. 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
                                  • 48. Claim.provider.extension:dataAbsentReason
                                    Slice NamedataAbsentReason
                                    Definition

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

                                    Shortunknown | asked | temp | notasked | masked | unsupported | astext | error
                                    Control1..1
                                    TypeExtension(Data Absent Reason) (Extension Type: code)
                                    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:dataAbsentReason.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
                                    This element is affected by the following invariants: ele-1
                                    Typeid
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    52. Claim.provider.extension:dataAbsentReason.extension
                                    Definition

                                    An Extension

                                    ShortExtension
                                    Control0..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.provider.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 54. Claim.provider.extension:dataAbsentReason.url
                                      Definition

                                      Source of the definition for the extension code - a logical name or a URL.

                                      Shortidentifies the meaning of the extension
                                      Comments

                                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                      Control1..1
                                      Typeuri
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      Fixed Valuehttp://hl7.org/fhir/StructureDefinition/data-absent-reason
                                      56. Claim.provider.extension:dataAbsentReason.value[x]
                                      Definition

                                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                      ShortValue of extension
                                      Control1..1
                                      This element is affected by the following invariants: ext-1
                                      BindingThe codes SHALL be taken from DataAbsentReason
                                      (required to http://hl7.org/fhir/ValueSet/data-absent-reason)
                                      Typecode
                                      [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
                                      Pattern Valuenot-applicable
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      58. 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..0
                                      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()))
                                      60. 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..0
                                      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()))
                                      62. 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..0
                                      TypeIdentifier
                                      Is Modifierfalse
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      64. 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..0
                                      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()))
                                      66. 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()))
                                      68. 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..0
                                      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()))
                                      70. 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()))
                                      72. 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
                                      74. 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())
                                      76. 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())
                                      78. 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()))
                                      80. 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()))
                                      82. 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()))
                                      84. Claim.prescription
                                      Definition

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

                                      ShortPrescription authorizing services and products
                                      Control0..0
                                      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()))
                                      86. 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..0
                                      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()))
                                      88. 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..0
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      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()))
                                      95. 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..0
                                      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()))
                                      97. Claim.facility
                                      Definition

                                      Facility where the services were provided.

                                      ShortServicing facility
                                      Control0..0
                                      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()))
                                      99. 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
                                      • 101. 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
                                        103. 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())
                                        105. 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())
                                        107. 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()))
                                        109. 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()))
                                        111. 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()))
                                        113. 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()))
                                        115. 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()))
                                        117. Claim.careTeam:attending
                                        Slice Nameattending
                                        Definition

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

                                        ShortMembers of the care team
                                        Control0..1
                                        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()))
                                        119. Claim.careTeam:attending.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
                                        121. Claim.careTeam:attending.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())
                                        123. Claim.careTeam:attending.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())
                                        125. Claim.careTeam:attending.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()))
                                        127. Claim.careTeam:attending.provider
                                        Definition

                                        Member of the team who provided the product or service.

                                        ShortPractitioner or organization
                                        Control1..1
                                        TypeReference(PCT Practitioner)
                                        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()))
                                        129. Claim.careTeam:attending.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()))
                                        131. Claim.careTeam:attending.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",
                                            "version" : "1.0.1",
                                            "code" : "attending"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        133. Claim.careTeam:attending.qualification
                                        Definition

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

                                        ShortPractitioner credential or specialization
                                        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()))
                                        135. Claim.careTeam:operating
                                        Slice Nameoperating
                                        Definition

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

                                        ShortMembers of the care team
                                        Control0..2
                                        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()))
                                        137. Claim.careTeam:operating.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
                                        139. Claim.careTeam:operating.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())
                                        141. Claim.careTeam:operating.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())
                                        143. Claim.careTeam:operating.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()))
                                        145. Claim.careTeam:operating.provider
                                        Definition

                                        Member of the team who provided the product or service.

                                        ShortPractitioner or organization
                                        Control1..1
                                        TypeReference(PCT Practitioner)
                                        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()))
                                        147. Claim.careTeam:operating.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()))
                                        149. Claim.careTeam:operating.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",
                                            "version" : "1.0.1",
                                            "code" : "operating"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        151. Claim.careTeam:operating.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()))
                                        153. Claim.careTeam:rendering
                                        Slice Namerendering
                                        Definition

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

                                        ShortMembers of the care team
                                        Control0..1
                                        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()))
                                        155. 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
                                        157. 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())
                                        159. 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())
                                        161. 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()))
                                        163. Claim.careTeam:rendering.provider
                                        Definition

                                        Member of the team who provided the product or service.

                                        ShortPractitioner or organization
                                        Control1..1
                                        TypeReference(PCT Practitioner)
                                        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()))
                                        165. 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()))
                                        167. 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",
                                            "version" : "1.0.1",
                                            "code" : "rendering"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        169. Claim.careTeam:rendering.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()))
                                        171. 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
                                        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()))
                                        173. 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
                                        175. 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())
                                        177. 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())
                                        179. 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()))
                                        181. 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()))
                                        183. 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()))
                                        185. 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",
                                            "version" : "1.0.1",
                                            "code" : "referring"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        187. 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()))
                                        189. 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..0
                                        TypeBackboneElement
                                        Is Modifierfalse
                                        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()))
                                        200. 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
                                        • 202. 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
                                          204. 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())
                                          206. 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())
                                          208. 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()))
                                          210. 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()))
                                          212. 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 Diagnosis Type Codes
                                          (required to http://terminology.hl7.org/ValueSet/diagnosistype)
                                          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()))
                                          214. 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()))
                                          216. 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()))
                                          218. 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()))
                                          220. 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
                                          222. 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())
                                          224. 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())
                                          226. 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()))
                                          228. 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()))
                                          230. 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 Diagnosis Type Codes
                                          (required to http://terminology.hl7.org/ValueSet/diagnosistype)
                                          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/diagnosistype",
                                              "code" : "principal"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          232. 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()))
                                          234. 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()))
                                          236. Claim.diagnosis:admitting
                                          Slice Nameadmitting
                                          Definition

                                          Information about diagnoses relevant to the claim items.

                                          ShortPertinent diagnosis information
                                          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()))
                                          238. Claim.diagnosis:admitting.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
                                          240. Claim.diagnosis:admitting.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())
                                          242. Claim.diagnosis:admitting.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())
                                          244. Claim.diagnosis:admitting.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()))
                                          246. Claim.diagnosis:admitting.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()))
                                          248. Claim.diagnosis:admitting.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 Diagnosis Type Codes
                                          (required to http://terminology.hl7.org/ValueSet/diagnosistype)
                                          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/diagnosistype",
                                              "code" : "admitting"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          250. Claim.diagnosis:admitting.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()))
                                          252. Claim.diagnosis:admitting.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()))
                                          254. Claim.diagnosis:patientReasonForVisit
                                          Slice NamepatientReasonForVisit
                                          Definition

                                          Information about diagnoses relevant to the claim items.

                                          ShortPertinent diagnosis information
                                          Control0..3
                                          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()))
                                          256. Claim.diagnosis:patientReasonForVisit.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
                                          258. Claim.diagnosis:patientReasonForVisit.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())
                                          260. Claim.diagnosis:patientReasonForVisit.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())
                                          262. Claim.diagnosis:patientReasonForVisit.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()))
                                          264. Claim.diagnosis:patientReasonForVisit.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()))
                                          266. Claim.diagnosis:patientReasonForVisit.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 Diagnosis Type Codes
                                          (required to http://terminology.hl7.org/ValueSet/diagnosistype)
                                          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/diagnosistype",
                                              "code" : "patientreasonforvisit"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          268. Claim.diagnosis:patientReasonForVisit.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()))
                                          270. Claim.diagnosis:patientReasonForVisit.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()))
                                          272. Claim.diagnosis:externalcauseofinjury
                                          Slice Nameexternalcauseofinjury
                                          Definition

                                          Information about diagnoses relevant to the claim items.

                                          ShortPertinent diagnosis information
                                          Control0..12
                                          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()))
                                          274. Claim.diagnosis:externalcauseofinjury.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
                                          276. Claim.diagnosis:externalcauseofinjury.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())
                                          278. Claim.diagnosis:externalcauseofinjury.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())
                                          280. Claim.diagnosis:externalcauseofinjury.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()))
                                          282. Claim.diagnosis:externalcauseofinjury.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()))
                                          284. Claim.diagnosis:externalcauseofinjury.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 Diagnosis Type Codes
                                          (required to http://terminology.hl7.org/ValueSet/diagnosistype)
                                          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/diagnosistype",
                                              "code" : "externalcauseofinjury"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          286. Claim.diagnosis:externalcauseofinjury.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()))
                                          288. Claim.diagnosis:externalcauseofinjury.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()))
                                          290. Claim.diagnosis:other
                                          Slice Nameother
                                          Definition

                                          Information about diagnoses relevant to the claim items.

                                          ShortPertinent diagnosis information
                                          Control0..24
                                          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()))
                                          292. 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
                                          294. 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())
                                          296. 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())
                                          298. 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()))
                                          300. 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
                                          Must Supporttrue
                                          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()))
                                          302. 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 Diagnosis Type Codes
                                          (required to http://terminology.hl7.org/ValueSet/diagnosistype)
                                          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/diagnosistype",
                                              "code" : "secondary"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          304. 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()))
                                          306. 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()))
                                          308. 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
                                          • 310. 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
                                            312. 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
                                            • 314. 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())
                                              316. 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())
                                              318. 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()))
                                              320. 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()))
                                              322. 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()))
                                              324. 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()))
                                              326. 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()))
                                              328. Claim.procedure:principal
                                              Slice Nameprincipal
                                              Definition

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

                                              ShortPrincipal clinical procedure performed
                                              Control0..1
                                              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()))
                                              330. Claim.procedure: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
                                              332. Claim.procedure:principal.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
                                              • 334. Claim.procedure:principal.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())
                                                336. Claim.procedure: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())
                                                338. Claim.procedure:principal.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.

                                                Pattern Value1
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                340. Claim.procedure:principal.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" : "principal"
                                                  }]
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                342. Claim.procedure:principal.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()))
                                                344. Claim.procedure:principal.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 ICD-10 Procedure Codes
                                                (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes)
                                                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()))
                                                346. Claim.procedure:principal.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()))
                                                348. 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()))
                                                350. 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
                                                352. 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
                                                • 354. 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())
                                                  356. 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())
                                                  358. 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()))
                                                  360. 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()))
                                                  362. 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()))
                                                  364. 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()))
                                                  366. 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()))
                                                  368. 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()))
                                                  370. 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
                                                  372. 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
                                                  • 374. 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())
                                                    376. 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())
                                                    378. 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()))
                                                    380. 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()))
                                                    382. 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()))
                                                    384. 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()))
                                                    386. 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()))
                                                    388. 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()))
                                                    390. 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
                                                    392. 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())
                                                    394. 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())
                                                    396. 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()))
                                                    398. 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()))
                                                    400. 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()))
                                                    402. 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()))
                                                    404. 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()))
                                                    406. 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..0
                                                    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()))
                                                    408. 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()))
                                                    410. 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()))
                                                    412. 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
                                                    414. 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())
                                                    416. 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())
                                                    418. 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()))
                                                    420. 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 (3.0.0)
                                                    (extensible to http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|3.0.0)

                                                    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()))
                                                    422. 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()))
                                                    424. 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
                                                    426. 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
                                                    • 428. 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.

                                                      ExampleGeneral: home
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      430. 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
                                                      ExampleGeneral: both
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      432. 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.

                                                      ExampleGeneral: 137 Nowhere Street, Erewhon 9132
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      434. 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
                                                      ExampleGeneral: 137 Nowhere Street
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      436. 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
                                                      ExampleGeneral: Erewhon
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      438. 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
                                                      ExampleGeneral: Madison
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      440. 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()))
                                                      442. 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
                                                      ExampleGeneral: 9132
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      444. 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()))
                                                      446. 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.

                                                      ExampleGeneral: { "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()))
                                                      448. 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
                                                      Control0..0
                                                      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()))
                                                      503. Claim.total
                                                      Definition

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

                                                      ShortTotal GFE Charges
                                                      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()))