Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot 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-ballot 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 found here

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
    ShortDisclaimers the patient should be made aware of regarding 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.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    SlicingThis element introduces a set of slices on Claim.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ type
    • 10. Claim.identifier:INTER
      Slice NameINTER
      ShortIntermediary System Identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      12. Claim.identifier:INTER.type
      Control1..?
      Pattern Value{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType",
          "code" : "INTER",
          "display" : "Intermediary System Identifier"
        }]
      }
      14. Claim.type
      Pattern Value{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse",
          "code" : "estimate-summary"
        }]
      }
      16. Claim.subType
      Control0..0
      18. Claim.use
      Pattern Valuepredetermination
      20. Claim.patient
      TypeReference(HRex Patient Demographics)
      22. 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
      24. Claim.enterer
      Control0..0
      26. Claim.insurer
      TypeReference(PCT Organization)
      Must Supporttrue
      28. Claim.provider
      30. Claim.provider.extension
      Control1..?
      32. Claim.provider.extension:dataAbsentReason
      Slice NamedataAbsentReason
      Control1..1
      TypeExtension(Data Absent Reason) (Extension Type: code)
      34. Claim.provider.extension:dataAbsentReason.value[x]
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Pattern Valuenot-applicable
      36. Claim.provider.reference
      Control0..0
      38. Claim.provider.type
      Control0..0
      40. Claim.provider.identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..0
      42. Claim.provider.display
      Control0..0
      44. Claim.priority
      BindingThe codes SHALL be taken from ProcessPriorityCodes
      (required to http://hl7.org/fhir/ValueSet/process-priority)
      46. Claim.fundsReserve
      Control0..0
      48. Claim.prescription
      Control0..0
      50. Claim.originalPrescription
      Control0..0
      52. Claim.payee
      Control0..0
      54. Claim.referral
      Control0..0
      56. Claim.facility
      Control0..0
      58. 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:
      • pattern @ role
      • 60. Claim.careTeam.provider
        TypeReference(PCT Practitioner, PCT Organization)
        62. 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)
        64. 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)
        66. Claim.careTeam:attending
        Slice Nameattending
        Control0..1
        Must Supporttrue
        68. Claim.careTeam:attending.provider
        TypeReference(PCT Practitioner)
        70. Claim.careTeam:attending.role
        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
            "code" : "attending"
          }]
        }
        72. Claim.careTeam:attending.qualification
        Control1..?
        74. Claim.careTeam:operating
        Slice Nameoperating
        Control0..2
        Must Supporttrue
        76. Claim.careTeam:operating.provider
        TypeReference(PCT Practitioner)
        78. Claim.careTeam:operating.role
        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
            "code" : "operating"
          }]
        }
        80. Claim.careTeam:rendering
        Slice Namerendering
        Control0..1
        Must Supporttrue
        82. Claim.careTeam:rendering.provider
        TypeReference(PCT Practitioner)
        84. Claim.careTeam:rendering.role
        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
            "code" : "rendering"
          }]
        }
        86. Claim.careTeam:referring
        Slice Namereferring
        Control0..1
        Must Supporttrue
        88. Claim.careTeam:referring.role
        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
            "code" : "referring"
          }]
        }
        90. Claim.supportingInfo
        Control0..0
        92. Claim.diagnosis
        Control1..?
        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:
        • pattern @ type
        • 94. Claim.diagnosis.type
          BindingThe codes SHALL be taken from PCT Diagnosis Type Value Set
          (required to http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS)
          Must Supporttrue
          96. Claim.diagnosis:principal
          Slice Nameprincipal
          Control1..1
          98. Claim.diagnosis:principal.sequence
          Pattern Value1
          100. 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]
          102. Claim.diagnosis:principal.type
          Control1..1
          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
              "code" : "principal"
            }]
          }
          104. Claim.diagnosis:admitting
          Slice Nameadmitting
          Control0..1
          Must Supporttrue
          106. 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]
          108. Claim.diagnosis:admitting.type
          Control1..1
          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
              "code" : "admitting"
            }]
          }
          110. Claim.diagnosis:patientReasonForVisit
          Slice NamepatientReasonForVisit
          Control0..3
          Must Supporttrue
          112. 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]
          114. Claim.diagnosis:patientReasonForVisit.type
          Control1..1
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
              "code" : "patientReasonForVisit"
            }]
          }
          116. Claim.diagnosis:externalcauseofinjury
          Slice Nameexternalcauseofinjury
          Control0..12
          Must Supporttrue
          118. 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]
          120. Claim.diagnosis:externalcauseofinjury.type
          Control1..1
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
              "code" : "externalCauseOfInjury"
            }]
          }
          122. Claim.diagnosis:other
          Slice Nameother
          Control0..24
          Must Supporttrue
          124. 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
          126. Claim.diagnosis:other.type
          Control1..1
          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
              "code" : "other"
            }]
          }
          128. 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:
          • pattern @ type
          • 130. 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
            • 132. Claim.procedure.extension:serviceDescription
              Slice NameserviceDescription
              Control1..1
              TypeExtension(Service Description) (Extension Type: string)
              134. 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
              136. Claim.procedure:principal
              Slice Nameprincipal
              ShortPrincipal clinical procedure performed
              Control0..1
              Must Supporttrue
              138. Claim.procedure:principal.extension:serviceDescription
              Slice NameserviceDescription
              Control1..1
              TypeExtension(Service Description) (Extension Type: string)
              140. Claim.procedure:principal.sequence
              Pattern Value1
              142. Claim.procedure:principal.type
              Control1..1
              Pattern Value{
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                  "code" : "principal"
                }]
              }
              144. 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]
              146. Claim.procedure:other
              Slice Nameother
              Control0..24
              Must Supporttrue
              148. Claim.procedure:other.extension:serviceDescription
              Slice NameserviceDescription
              Control1..1
              TypeExtension(Service Description) (Extension Type: string)
              150. Claim.procedure:other.type
              Control1..1
              Pattern Value{
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
                  "code" : "other"
                }]
              }
              152. 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]
              154. Claim.insurance
              156. Claim.insurance.coverage
              TypeReference(PCT Coverage)
              158. Claim.insurance.preAuthRef
              Control0..0
              160. Claim.accident
              162. Claim.accident.location[x]
              TypeAddress, Reference(Location)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              164. Claim.accident.location[x].country
              BindingThe codes SHALL be taken from Iso3166-1-2
              (required to http://hl7.org/fhir/ValueSet/iso3166-1-2)
              166. Claim.item
              Control0..0
              168. Claim.total
              ShortTotal GFE Charges
              Control1..?

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

              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

                ShortDisclaimers the patient should be made aware of regarding the estimate
                Control0..*
                This element is affected by the following invariants: ele-1
                TypeExtension(GFEDisclaimer) (Extension Type: string)
                Is Modifierfalse
                Must Supporttrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                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
                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.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()))
                SlicingThis element introduces a set of slices on Claim.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • pattern @ type
                • 14. Claim.identifier:INTER
                  Slice NameINTER
                  Definition

                  A unique identifier assigned to this claim.

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

                  Allows claims to be distinguished and referenced.

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

                  The purpose of this identifier.

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

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

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

                  Identifies the purpose for this identifier, if known .

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

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

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

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

                  ShortDescription of identifier
                  Comments

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

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

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

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Requirements

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

                  Pattern Value{
                    "coding" : [{
                      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType",
                      "code" : "INTER",
                      "display" : "Intermediary System Identifier"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  20. 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()))
                  22. 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()))
                  24. 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()))
                  26. 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()))
                  28. Claim.patient
                  Definition

                  The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

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

                  The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  30. 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()))
                  32. 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()))
                  34. 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()))
                  36. 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()))
                  38. 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()))
                  40. 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
                  • 42. 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())
                    44. 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
                    • 46. 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
                      48. 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()))
                      50. 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()))
                      52. 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()))
                      54. 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()))
                      56. 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()))
                      58. 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()))
                      60. 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()))
                      62. 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()))
                      64. 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()))
                      66. 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()))
                      70. 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()))
                      72. 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()))
                      74. 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:
                      • pattern @ role
                      • 76. 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())
                        78. 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()))
                        80. 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()))
                        82. 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()))
                        84. 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()))
                        86. 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()))
                        88. 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())
                        90. 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()))
                        92. 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()))
                        94. 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.

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

                        The role codes for the care team members.

                        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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
                            "code" : "attending"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        96. Claim.careTeam:attending.qualification
                        Definition

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

                        ShortPractitioner credential or specialization
                        Control10..1
                        BindingFor example codes, see ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualification
                        (example to http://hl7.org/fhir/ValueSet/provider-qualification)

                        Provider professional qualifications.

                        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()))
                        98. 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()))
                        100. 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())
                        102. 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()))
                        104. 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()))
                        106. 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.

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

                        The role codes for the care team members.

                        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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
                            "code" : "operating"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        108. 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()))
                        110. 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())
                        112. 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()))
                        114. 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()))
                        116. 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.

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

                        The role codes for the care team members.

                        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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
                            "code" : "rendering"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        118. 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()))
                        120. 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())
                        122. 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()))
                        124. Claim.careTeam:referring.provider
                        Definition

                        Member of the team who provided the product or service.

                        ShortPractitioner or organization
                        Control1..1
                        TypeReference(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()))
                        126. 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.

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

                        The role codes for the care team members.

                        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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
                            "code" : "referring"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        128. 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()))
                        133. Claim.diagnosis
                        Definition

                        Information about diagnoses relevant to the claim items.

                        ShortPertinent diagnosis information
                        Control10..*
                        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:
                        • pattern @ type
                        • 135. 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())
                          137. 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()))
                          139. 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()))
                          141. Claim.diagnosis.type
                          Definition

                          When the condition was observed or the relative ranking.

                          ShortTiming or nature of the diagnosis
                          Comments

                          For example: admitting, primary, secondary, discharge.

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

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

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

                          Information about diagnoses relevant to the claim items.

                          ShortPertinent diagnosis information
                          Control10..1*
                          TypeBackboneElement
                          Is Modifierfalse
                          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()))
                          145. 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())
                          147. 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()))
                          149. 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()))
                          151. 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*
                          BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                          (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                          The type of the diagnosis: admitting, principal, discharge.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                              "code" : "principal"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          153. 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()))
                          155. 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())
                          157. 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()))
                          159. 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()))
                          161. 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*
                          BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                          (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                          The type of the diagnosis: admitting, principal, discharge.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                              "code" : "admitting"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          163. 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()))
                          165. 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())
                          167. 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()))
                          169. 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()))
                          171. 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*
                          BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                          (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                          The type of the diagnosis: admitting, principal, discharge.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
                              "code" : "patientReasonForVisit"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          173. 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()))
                          175. 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())
                          177. 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()))
                          179. 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()))
                          181. 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*
                          BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                          (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                          The type of the diagnosis: admitting, principal, discharge.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
                              "code" : "externalCauseOfInjury"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          183. 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()))
                          185. 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())
                          187. 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()))
                          189. 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()))
                          191. 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*
                          BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                          (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                          The type of the diagnosis: admitting, principal, discharge.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

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

                          Pattern Value{
                            "coding" : [{
                              "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
                              "code" : "other"
                            }]
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          193. 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:
                          • pattern @ type
                          • 195. 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
                            • 197. 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
                              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())
                              199. 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())
                              201. 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()))
                              203. 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()))
                              205. 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()))
                              207. 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()))
                              209. 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
                              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())
                              211. 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())
                              213. 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()))
                              215. Claim.procedure:principal.type
                              Definition

                              When the condition was observed or the relative ranking.

                              ShortCategory of Procedure
                              Comments

                              For example: primary, secondary.

                              Control10..1*
                              BindingFor example codes, see ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type
                              (example to http://hl7.org/fhir/ValueSet/ex-procedure-type)

                              Example procedure type codes.

                              TypeCodeableConcept
                              Is Modifierfalse
                              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()))
                              217. 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()))
                              219. 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()))
                              221. 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
                              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())
                              223. 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())
                              225. 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()))
                              227. Claim.procedure:other.type
                              Definition

                              When the condition was observed or the relative ranking.

                              ShortCategory of Procedure
                              Comments

                              For example: primary, secondary.

                              Control10..1*
                              BindingFor example codes, see ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type
                              (example to http://hl7.org/fhir/ValueSet/ex-procedure-type)

                              Example procedure type codes.

                              TypeCodeableConcept
                              Is Modifierfalse
                              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()))
                              229. 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()))
                              231. 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()))
                              233. 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())
                              235. 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()))
                              237. 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()))
                              239. 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()))
                              241. 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()))
                              243. 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()))
                              248. 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 found here

                              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

                                ShortDisclaimers the patient should be made aware of regarding the estimate
                                Control0..*
                                This element is affected by the following invariants: ele-1
                                TypeExtension(GFEDisclaimer) (Extension Type: string)
                                Is Modifierfalse
                                Must Supporttrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                18. Claim.extension: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
                                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()))
                                SlicingThis element introduces a set of slices on Claim.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • pattern @ type
                                • 24. Claim.identifier:INTER
                                  Slice NameINTER
                                  Definition

                                  A unique identifier assigned to this claim.

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

                                  Allows claims to be distinguished and referenced.

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

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

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

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

                                    The purpose of this identifier.

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

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

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

                                    Identifies the purpose for this identifier, if known .

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

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

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

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

                                    ShortDescription of identifier
                                    Comments

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

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

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

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summarytrue
                                    Requirements

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

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

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

                                    ShortThe namespace for the identifier value
                                    Comments

                                    Identifier.system is always case sensitive.

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

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

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

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

                                    ShortThe value that is unique
                                    Comments

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

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

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

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

                                    Organization that issued/manages the identifier.

                                    ShortOrganization that issued id (may be just text)
                                    Comments

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

                                    Control0..1
                                    TypeReference(Organization)
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    42. 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()))
                                    44. 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()))
                                    46. 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()))
                                    48. 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()))
                                    50. Claim.patient
                                    Definition

                                    The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

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

                                    The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    52. 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()))
                                    54. 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()))
                                    56. 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()))
                                    58. 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()))
                                    60. 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()))
                                    62. 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
                                    64. 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
                                    • 66. 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())
                                      68. 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
                                      70. 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
                                      • 72. 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
                                        74. 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()))
                                        76. 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()))
                                        78. 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()))
                                        80. 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()))
                                        82. 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()))
                                        84. 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()))
                                        86. 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()))
                                        88. 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()))
                                        90. 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
                                        92. 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())
                                        94. 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())
                                        96. 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()))
                                        98. 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()))
                                        100. 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()))
                                        102. 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()))
                                        104. 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()))
                                        106. 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()))
                                        113. 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()))
                                        115. 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()))
                                        117. 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:
                                        • pattern @ role
                                        • 119. 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
                                          121. 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())
                                          123. 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())
                                          125. 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()))
                                          127. 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()))
                                          129. 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()))
                                          131. 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()))
                                          133. 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()))
                                          135. 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()))
                                          137. 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
                                          139. 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())
                                          141. 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())
                                          143. 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()))
                                          145. 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()))
                                          147. 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()))
                                          149. 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.

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

                                          The role codes for the care team members.

                                          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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
                                              "code" : "attending"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          151. Claim.careTeam:attending.qualification
                                          Definition

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

                                          ShortPractitioner credential or specialization
                                          Control1..1
                                          BindingFor example codes, see ExampleProviderQualificationCodes
                                          (example to http://hl7.org/fhir/ValueSet/provider-qualification)

                                          Provider professional qualifications.

                                          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: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()))
                                          155. 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
                                          157. 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())
                                          159. 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())
                                          161. 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()))
                                          163. 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()))
                                          165. 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()))
                                          167. 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.

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

                                          The role codes for the care team members.

                                          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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
                                              "code" : "operating"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          169. Claim.careTeam:operating.qualification
                                          Definition

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

                                          ShortPractitioner credential or specialization
                                          Control0..1
                                          BindingFor example codes, see ExampleProviderQualificationCodes
                                          (example to http://hl7.org/fhir/ValueSet/provider-qualification)

                                          Provider professional qualifications.

                                          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: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()))
                                          173. 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
                                          175. 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())
                                          177. 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())
                                          179. 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()))
                                          181. 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()))
                                          183. 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()))
                                          185. 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.

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

                                          The role codes for the care team members.

                                          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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
                                              "code" : "rendering"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          187. Claim.careTeam:rendering.qualification
                                          Definition

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

                                          ShortPractitioner credential or specialization
                                          Control0..1
                                          BindingFor example codes, see ExampleProviderQualificationCodes
                                          (example to http://hl7.org/fhir/ValueSet/provider-qualification)

                                          Provider professional qualifications.

                                          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.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()))
                                          191. 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
                                          193. 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())
                                          195. 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())
                                          197. 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()))
                                          199. Claim.careTeam:referring.provider
                                          Definition

                                          Member of the team who provided the product or service.

                                          ShortPractitioner or organization
                                          Control1..1
                                          TypeReference(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()))
                                          201. 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()))
                                          203. 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.

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

                                          The role codes for the care team members.

                                          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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole",
                                              "code" : "referring"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          205. Claim.careTeam:referring.qualification
                                          Definition

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

                                          ShortPractitioner credential or specialization
                                          Control0..1
                                          BindingFor example codes, see ExampleProviderQualificationCodes
                                          (example to http://hl7.org/fhir/ValueSet/provider-qualification)

                                          Provider professional qualifications.

                                          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()))
                                          207. 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()))
                                          218. Claim.diagnosis
                                          Definition

                                          Information about diagnoses relevant to the claim items.

                                          ShortPertinent diagnosis information
                                          Control1..*
                                          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:
                                          • pattern @ type
                                          • 220. 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
                                            222. 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())
                                            224. 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())
                                            226. 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()))
                                            228. 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()))
                                            230. Claim.diagnosis.type
                                            Definition

                                            When the condition was observed or the relative ranking.

                                            ShortTiming or nature of the diagnosis
                                            Comments

                                            For example: admitting, primary, secondary, discharge.

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

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

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            232. 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()))
                                            234. 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()))
                                            236. Claim.diagnosis:principal
                                            Slice Nameprincipal
                                            Definition

                                            Information about diagnoses relevant to the claim items.

                                            ShortPertinent diagnosis information
                                            Control1..1
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            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: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
                                            240. 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())
                                            242. 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())
                                            244. 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()))
                                            246. 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()))
                                            248. 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
                                            BindingFor example codes, see ExampleDiagnosisTypeCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                                            The type of the diagnosis: admitting, principal, discharge.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

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

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                                                "code" : "principal"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            250. 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()))
                                            252. 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()))
                                            254. 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()))
                                            256. 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
                                            258. 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())
                                            260. 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())
                                            262. 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()))
                                            264. 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()))
                                            266. 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
                                            BindingFor example codes, see ExampleDiagnosisTypeCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                                            The type of the diagnosis: admitting, principal, discharge.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

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

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                                                "code" : "admitting"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            268. 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()))
                                            270. 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()))
                                            272. 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()))
                                            274. 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
                                            276. 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())
                                            278. 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())
                                            280. 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()))
                                            282. 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()))
                                            284. 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
                                            BindingFor example codes, see ExampleDiagnosisTypeCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                                            The type of the diagnosis: admitting, principal, discharge.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

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

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
                                                "code" : "patientReasonForVisit"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            286. 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()))
                                            288. 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()))
                                            290. 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()))
                                            292. 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
                                            294. 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())
                                            296. 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())
                                            298. 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()))
                                            300. 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()))
                                            302. 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
                                            BindingFor example codes, see ExampleDiagnosisTypeCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                                            The type of the diagnosis: admitting, principal, discharge.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

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

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType",
                                                "code" : "externalCauseOfInjury"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            304. 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()))
                                            306. 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()))
                                            308. 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()))
                                            310. 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
                                            312. 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())
                                            314. 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
                                            Invaria