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

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON
• TTL

Resource Profile: PCT Good Faith Estimate Summary

PCT Good Faith Estimate Summary is a profile for summarizing costs associated with a set of Good Faith Estimate Claims for a single Period of Care.

Usages:

• Use this Profile: PCT GFE Bundle
• Examples for this Profile: Claim/PCT-GFE-Summary-1 and Claim/PCT-GFE-Summary-MRI

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer	S	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription	S	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: estimate-summary
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination
patient	Σ	1..1	Reference(US Core Patient Profile(7.0.0))	The recipient of the products and services
billablePeriod	SΣ	0..1	Period	The full Period of Care for all services or products included in the estimate from the first event to the last event.
created	Σ	1..1	dateTime	Resource creation date
insurer	SΣ	0..1	Reference(PCT Organization)	Target
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason		1..1	(Complex)	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x]		1..1	code	Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required)
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending	S	0..1	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: attending
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		1..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:operating	S	0..2	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: operating
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
careTeam:rendering	S	0..1	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rendering
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
careTeam:referring	S	0..1	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: referring
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type	S	0..*	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
diagnosis:principal	S	0..1	BackboneElement	Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier Required Pattern: 1
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
diagnosis:admitting	S	0..1	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admitting
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
diagnosis:patientReasonForVisit	S	0..3	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
diagnosis:externalcauseofinjury	S	0..12	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
diagnosis:other	S	0..24	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: secondary
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for procedure	S	0..*	BackboneElement	Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices				Content/Rules for all slices
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	0..*	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required)
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
procedure:principal	S	0..1	BackboneElement	Principal clinical procedure performed
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier Required Pattern: 1
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
procedure:anesthesiaRelated	S	0..2	BackboneElement	Clinical procedures performed
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
procedure:other	S	0..24	BackboneElement	Clinical procedures performed
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: other
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
insurance	Σ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(PCT Coverage)	Insurance information
total		1..1	Money	Total GFE Charges
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Claim.type	extensible	Pattern Value: estimate-summary http://hl7.org/fhir/ValueSet/claim-type From the FHIR Standard
Claim.use	required	Pattern Value: predetermination http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
Claim.provider.extension:dataAbsentReason.value[x]	required	Pattern Value: not-applicable http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.payee.type	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
Claim.careTeam.role	required	PCTCareTeamRoleVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:attending.role	required	Pattern Value: attending http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:attending.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:operating.role	required	Pattern Value: operating http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:rendering.role	required	Pattern Value: rendering http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:referring.role	required	Pattern Value: referring http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.supportingInfo.category	example	ClaimInformationCategoryCodes http://hl7.org/fhir/ValueSet/claim-informationcategory From the FHIR Standard
Claim.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard
Claim.diagnosis.type	required	DiagnosisTypeCodes http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:principal.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:principal.type	required	Pattern Value: principal http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:admitting.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:admitting.type	required	Pattern Value: admitting http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:patientReasonForVisit.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:patientReasonForVisit.type	required	Pattern Value: patientreasonforvisit http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:externalcauseofinjury.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:externalcauseofinjury.type	required	Pattern Value: externalcauseofinjury http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:other.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:other.type	required	Pattern Value: secondary http://terminology.hl7.org/ValueSet/diagnosistype
Claim.procedure.type	required	PCTProcedureTypeVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure.procedure[x]	example	ICD-10ProcedureCodes http://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard
Claim.procedure:principal.type	required	Pattern Value: principal http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:principal.procedure[x]	required	ICD10ProcedureCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes From this IG
Claim.procedure:anesthesiaRelated.type	required	Pattern Value: procedureRequiringAnesthesia http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:anesthesiaRelated.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.procedure:other.type	required	Pattern Value: other http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:other.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Claim	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	error	Claim	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	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim			Claim
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer	S	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription	S	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type		1..1	CodeableConcept	Category or discipline Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
code		1..1	code	Symbol in syntax defined by the system Fixed Value: estimate-summary
subType		0..0
use		1..1	code	claim | preauthorization | predetermination Required Pattern: predetermination
patient		1..1	Reference(US Core Patient Profile(7.0.0))	The recipient of the products and services
billablePeriod	S	0..1	Period	The full Period of Care for all services or products included in the estimate from the first event to the last event.
enterer		0..0
insurer	S	0..1	Reference(PCT Organization)	Target
provider
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:dataAbsentReason		1..1	(Complex)	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x]		1..1	code	Value of extension Required Pattern: not-applicable
reference		0..0
type		0..0
identifier		0..0
display		0..0
priority		1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
fundsReserve		0..0
prescription		0..0
originalPrescription		0..0
payee		0..0
referral		0..0
facility		0..0
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices				Content/Rules for all slices
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required)
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending	S	0..1	BackboneElement	Members of the care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: attending
qualification		1..1	CodeableConcept	Practitioner credential or specialization
careTeam:operating	S	0..2	BackboneElement	Members of the care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: operating
careTeam:rendering	S	0..1	BackboneElement	Members of the care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rendering
careTeam:referring	S	0..1	BackboneElement	Members of the care team
role		1..1	CodeableConcept	Function within the team Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: referring
supportingInfo		0..0
Slices for diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices				Content/Rules for all slices
type	S	0..*	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
diagnosis:principal	S	0..1	BackboneElement	Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
sequence		1..1	positiveInt	Diagnosis instance identifier Required Pattern: 1
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
diagnosis:admitting	S	0..1	BackboneElement	Pertinent diagnosis information
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admitting
diagnosis:patientReasonForVisit	S	0..3	BackboneElement	Pertinent diagnosis information
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
diagnosis:externalcauseofinjury	S	0..12	BackboneElement	Pertinent diagnosis information
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
diagnosis:other	S	0..24	BackboneElement	Pertinent diagnosis information
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: secondary
Slices for procedure	S	0..*	BackboneElement	Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices				Content/Rules for all slices
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type	S	0..*	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required)
procedure:principal	S	0..1	BackboneElement	Principal clinical procedure performed
Slices for extension				Content/Rules for all slices
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
sequence		1..1	positiveInt	Procedure instance identifier Required Pattern: 1
type		1..1	CodeableConcept	Category of Procedure Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
procedure:anesthesiaRelated	S	0..2	BackboneElement	Clinical procedures performed
Slices for extension				Content/Rules for all slices
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type		1..1	CodeableConcept	Category of Procedure Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code		1..1	code	Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
procedure:other	S	0..24	BackboneElement	Clinical procedures performed
Slices for extension				Content/Rules for all slices
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type		1..1	CodeableConcept	Category of Procedure Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code		1..1	code	Symbol in syntax defined by the system Fixed Value: other
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
insurance
coverage		1..1	Reference(PCT Coverage)	Insurance information
preAuthRef		0..0
accident
location[x]		0..1	Address	Where the event occurred
country		0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: Iso3166-1-2 (required)
item		0..0
total		1..1	Money	Total GFE Charges
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.careTeam.role	required	PCTCareTeamRoleVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.diagnosis.type	required	DiagnosisTypeCodes http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:principal.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:admitting.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:patientReasonForVisit.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:externalcauseofinjury.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:other.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.procedure.type	required	PCTProcedureTypeVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:principal.procedure[x]	required	ICD10ProcedureCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes From this IG
Claim.procedure:anesthesiaRelated.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.procedure:other.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.accident.location[x].country	required	Iso3166-1-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 From the FHIR Standard

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer	S	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription	S	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business Identifier for claim
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: estimate-summary
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination
patient	Σ	1..1	Reference(US Core Patient Profile(7.0.0))	The recipient of the products and services
billablePeriod	SΣ	0..1	Period	The full Period of Care for all services or products included in the estimate from the first event to the last event.
created	Σ	1..1	dateTime	Resource creation date
insurer	SΣ	0..1	Reference(PCT Organization)	Target
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason		1..1	(Complex)	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x]		1..1	code	Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
related		0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required)
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending	S	0..1	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: attending
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		1..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:operating	S	0..2	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: operating
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:rendering	S	0..1	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rendering
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:referring	S	0..1	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: referring
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
Slices for diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type	S	0..*	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:principal	S	0..1	BackboneElement	Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier Required Pattern: 1
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:admitting	S	0..1	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admitting
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:patientReasonForVisit	S	0..3	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:externalcauseofinjury	S	0..12	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:other	S	0..24	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: secondary
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Slices for procedure	S	0..*	BackboneElement	Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	0..*	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required)
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
procedure:principal	S	0..1	BackboneElement	Principal clinical procedure performed
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier Required Pattern: 1
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
udi		0..*	Reference(Device)	Unique device identifier
procedure:anesthesiaRelated	S	0..2	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
udi		0..*	Reference(Device)	Unique device identifier
procedure:other	S	0..24	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: other
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
udi		0..*	Reference(Device)	Unique device identifier
insurance	Σ	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	Σ	1..1	Reference(PCT Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
accident		0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		1..1	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
location[x]		0..1	Address	Where the event occurred
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	Σ	0..*	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	Σ	0..1	string	Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	Σ	0..1	string	Sub-unit of country (abbreviations ok)
postalCode	Σ	0..1	string	Postal code for area Example General: 9132
country	Σ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: Iso3166-1-2 (required)
period	Σ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
total		1..1	Money	Total GFE Charges
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Claim.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Claim.type	extensible	Pattern Value: estimate-summary http://hl7.org/fhir/ValueSet/claim-type From the FHIR Standard
Claim.use	required	Pattern Value: predetermination http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
Claim.provider.extension:dataAbsentReason.value[x]	required	Pattern Value: not-applicable http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.related.relationship	example	ExampleRelatedClaimRelationshipCodes http://hl7.org/fhir/ValueSet/related-claim-relationship From the FHIR Standard
Claim.payee.type	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
Claim.careTeam.role	required	PCTCareTeamRoleVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:attending.role	required	Pattern Value: attending http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:attending.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:operating.role	required	Pattern Value: operating http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:operating.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:rendering.role	required	Pattern Value: rendering http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:rendering.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:referring.role	required	Pattern Value: referring http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:referring.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.supportingInfo.category	example	ClaimInformationCategoryCodes http://hl7.org/fhir/ValueSet/claim-informationcategory From the FHIR Standard
Claim.supportingInfo.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard
Claim.supportingInfo.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard
Claim.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard
Claim.diagnosis.type	required	DiagnosisTypeCodes http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:principal.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:principal.type	required	Pattern Value: principal http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:principal.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:principal.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:admitting.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:admitting.type	required	Pattern Value: admitting http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:admitting.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:admitting.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:patientReasonForVisit.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:patientReasonForVisit.type	required	Pattern Value: patientreasonforvisit http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:patientReasonForVisit.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:patientReasonForVisit.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:externalcauseofinjury.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:externalcauseofinjury.type	required	Pattern Value: externalcauseofinjury http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:externalcauseofinjury.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:externalcauseofinjury.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:other.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:other.type	required	Pattern Value: secondary http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:other.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:other.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.procedure.type	required	PCTProcedureTypeVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure.procedure[x]	example	ICD-10ProcedureCodes http://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard
Claim.procedure:principal.type	required	Pattern Value: principal http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:principal.procedure[x]	required	ICD10ProcedureCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes From this IG
Claim.procedure:anesthesiaRelated.type	required	Pattern Value: procedureRequiringAnesthesia http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:anesthesiaRelated.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.procedure:other.type	required	Pattern Value: other http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:other.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.accident.type	extensible	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|3.0.0
Claim.accident.location[x].use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 From the FHIR Standard
Claim.accident.location[x].type	required	AddressType http://hl7.org/fhir/ValueSet/address-type|4.0.1 From the FHIR Standard
Claim.accident.location[x].country	required	Iso3166-1-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 From the FHIR Standard
Claim.item.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
Claim.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
Claim.item.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place From the FHIR Standard
Claim.item.bodySite	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth From the FHIR Standard
Claim.item.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface From the FHIR Standard
Claim.item.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.detail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
Claim.item.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.detail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
Claim.item.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.detail.subDetail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
Claim.item.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.detail.subDetail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Claim	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	error	Claim	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	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Claim

Summary

Mandatory: 3 elements(15 nested mandatory elements)
Must-Support: 22 elements
Prohibited: 15 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)
• PCT Organization (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization)
• PCT Practitioner (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner)
• PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
• http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
• http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.careTeam
• The element 1 is sliced based on the value of Claim.diagnosis
• The element 1 is sliced based on the value of Claim.procedure

Maturity: 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer	S	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription	S	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: estimate-summary
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination
patient	Σ	1..1	Reference(US Core Patient Profile(7.0.0))	The recipient of the products and services
billablePeriod	SΣ	0..1	Period	The full Period of Care for all services or products included in the estimate from the first event to the last event.
created	Σ	1..1	dateTime	Resource creation date
insurer	SΣ	0..1	Reference(PCT Organization)	Target
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason		1..1	(Complex)	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x]		1..1	code	Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required)
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending	S	0..1	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: attending
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		1..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:operating	S	0..2	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: operating
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
careTeam:rendering	S	0..1	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rendering
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
careTeam:referring	S	0..1	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: referring
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type	S	0..*	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
diagnosis:principal	S	0..1	BackboneElement	Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier Required Pattern: 1
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
diagnosis:admitting	S	0..1	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admitting
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
diagnosis:patientReasonForVisit	S	0..3	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
diagnosis:externalcauseofinjury	S	0..12	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
diagnosis:other	S	0..24	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: secondary
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for procedure	S	0..*	BackboneElement	Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices				Content/Rules for all slices
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	0..*	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required)
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
procedure:principal	S	0..1	BackboneElement	Principal clinical procedure performed
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier Required Pattern: 1
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
procedure:anesthesiaRelated	S	0..2	BackboneElement	Clinical procedures performed
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
procedure:other	S	0..24	BackboneElement	Clinical procedures performed
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: other
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
insurance	Σ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(PCT Coverage)	Insurance information
total		1..1	Money	Total GFE Charges
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Claim.type	extensible	Pattern Value: estimate-summary http://hl7.org/fhir/ValueSet/claim-type From the FHIR Standard
Claim.use	required	Pattern Value: predetermination http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
Claim.provider.extension:dataAbsentReason.value[x]	required	Pattern Value: not-applicable http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.payee.type	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
Claim.careTeam.role	required	PCTCareTeamRoleVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:attending.role	required	Pattern Value: attending http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:attending.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:operating.role	required	Pattern Value: operating http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:rendering.role	required	Pattern Value: rendering http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:referring.role	required	Pattern Value: referring http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.supportingInfo.category	example	ClaimInformationCategoryCodes http://hl7.org/fhir/ValueSet/claim-informationcategory From the FHIR Standard
Claim.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard
Claim.diagnosis.type	required	DiagnosisTypeCodes http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:principal.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:principal.type	required	Pattern Value: principal http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:admitting.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:admitting.type	required	Pattern Value: admitting http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:patientReasonForVisit.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:patientReasonForVisit.type	required	Pattern Value: patientreasonforvisit http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:externalcauseofinjury.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:externalcauseofinjury.type	required	Pattern Value: externalcauseofinjury http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:other.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:other.type	required	Pattern Value: secondary http://terminology.hl7.org/ValueSet/diagnosistype
Claim.procedure.type	required	PCTProcedureTypeVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure.procedure[x]	example	ICD-10ProcedureCodes http://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard
Claim.procedure:principal.type	required	Pattern Value: principal http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:principal.procedure[x]	required	ICD10ProcedureCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes From this IG
Claim.procedure:anesthesiaRelated.type	required	Pattern Value: procedureRequiringAnesthesia http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:anesthesiaRelated.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.procedure:other.type	required	Pattern Value: other http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:other.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Claim	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	error	Claim	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	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim			Claim
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer	S	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription	S	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type		1..1	CodeableConcept	Category or discipline Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
code		1..1	code	Symbol in syntax defined by the system Fixed Value: estimate-summary
subType		0..0
use		1..1	code	claim | preauthorization | predetermination Required Pattern: predetermination
patient		1..1	Reference(US Core Patient Profile(7.0.0))	The recipient of the products and services
billablePeriod	S	0..1	Period	The full Period of Care for all services or products included in the estimate from the first event to the last event.
enterer		0..0
insurer	S	0..1	Reference(PCT Organization)	Target
provider
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:dataAbsentReason		1..1	(Complex)	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x]		1..1	code	Value of extension Required Pattern: not-applicable
reference		0..0
type		0..0
identifier		0..0
display		0..0
priority		1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
fundsReserve		0..0
prescription		0..0
originalPrescription		0..0
payee		0..0
referral		0..0
facility		0..0
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices				Content/Rules for all slices
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required)
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending	S	0..1	BackboneElement	Members of the care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: attending
qualification		1..1	CodeableConcept	Practitioner credential or specialization
careTeam:operating	S	0..2	BackboneElement	Members of the care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: operating
careTeam:rendering	S	0..1	BackboneElement	Members of the care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
role		1..1	CodeableConcept	Function within the team Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rendering
careTeam:referring	S	0..1	BackboneElement	Members of the care team
role		1..1	CodeableConcept	Function within the team Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: referring
supportingInfo		0..0
Slices for diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices				Content/Rules for all slices
type	S	0..*	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
diagnosis:principal	S	0..1	BackboneElement	Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
sequence		1..1	positiveInt	Diagnosis instance identifier Required Pattern: 1
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
diagnosis:admitting	S	0..1	BackboneElement	Pertinent diagnosis information
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admitting
diagnosis:patientReasonForVisit	S	0..3	BackboneElement	Pertinent diagnosis information
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
diagnosis:externalcauseofinjury	S	0..12	BackboneElement	Pertinent diagnosis information
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
diagnosis:other	S	0..24	BackboneElement	Pertinent diagnosis information
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type		1..1	CodeableConcept	Timing or nature of the diagnosis Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code		1..1	code	Symbol in syntax defined by the system Fixed Value: secondary
Slices for procedure	S	0..*	BackboneElement	Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices				Content/Rules for all slices
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type	S	0..*	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required)
procedure:principal	S	0..1	BackboneElement	Principal clinical procedure performed
Slices for extension				Content/Rules for all slices
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
sequence		1..1	positiveInt	Procedure instance identifier Required Pattern: 1
type		1..1	CodeableConcept	Category of Procedure Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
procedure:anesthesiaRelated	S	0..2	BackboneElement	Clinical procedures performed
Slices for extension				Content/Rules for all slices
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type		1..1	CodeableConcept	Category of Procedure Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code		1..1	code	Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
procedure:other	S	0..24	BackboneElement	Clinical procedures performed
Slices for extension				Content/Rules for all slices
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type		1..1	CodeableConcept	Category of Procedure Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code		1..1	code	Symbol in syntax defined by the system Fixed Value: other
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
insurance
coverage		1..1	Reference(PCT Coverage)	Insurance information
preAuthRef		0..0
accident
location[x]		0..1	Address	Where the event occurred
country		0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: Iso3166-1-2 (required)
item		0..0
total		1..1	Money	Total GFE Charges
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.careTeam.role	required	PCTCareTeamRoleVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.diagnosis.type	required	DiagnosisTypeCodes http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:principal.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:admitting.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:patientReasonForVisit.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:externalcauseofinjury.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:other.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.procedure.type	required	PCTProcedureTypeVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:principal.procedure[x]	required	ICD10ProcedureCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes From this IG
Claim.procedure:anesthesiaRelated.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.procedure:other.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.accident.location[x].country	required	Iso3166-1-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 From the FHIR Standard

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer	S	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription	S	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business Identifier for claim
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: estimate-summary
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination
patient	Σ	1..1	Reference(US Core Patient Profile(7.0.0))	The recipient of the products and services
billablePeriod	SΣ	0..1	Period	The full Period of Care for all services or products included in the estimate from the first event to the last event.
created	Σ	1..1	dateTime	Resource creation date
insurer	SΣ	0..1	Reference(PCT Organization)	Target
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason		1..1	(Complex)	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x]		1..1	code	Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
related		0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
Slices for careTeam	S	0..*	BackboneElement	Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required)
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending	S	0..1	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: attending
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		1..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:operating	S	0..2	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: operating
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:rendering	S	0..1	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rendering
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:referring	S	0..1	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(PCT Practitioner | PCT Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		1..1	CodeableConcept	Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: referring
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
Slices for diagnosis	S	0..*	BackboneElement	Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type	S	0..*	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:principal	S	0..1	BackboneElement	Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier Required Pattern: 1
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:admitting	S	0..1	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admitting
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:patientReasonForVisit	S	0..3	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:externalcauseofinjury	S	0..12	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:other	S	0..24	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: secondary
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Slices for procedure	S	0..*	BackboneElement	Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	0..*	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required)
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
procedure:principal	S	0..1	BackboneElement	Principal clinical procedure performed
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier Required Pattern: 1
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: principal
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
udi		0..*	Reference(Device)	Unique device identifier
procedure:anesthesiaRelated	S	0..2	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
udi		0..*	Reference(Device)	Unique device identifier
procedure:other	S	0..24	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:serviceDescription		1..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: other
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
udi		0..*	Reference(Device)	Unique device identifier
insurance	Σ	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	Σ	1..1	Reference(PCT Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
accident		0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		1..1	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
location[x]		0..1	Address	Where the event occurred
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type	Σ	0..1	code	postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text	Σ	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line	Σ	0..*	string	Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city	Σ	0..1	string	Name of city, town etc. Example General: Erewhon
district	Σ	0..1	string	District name (aka county) Example General: Madison
state	Σ	0..1	string	Sub-unit of country (abbreviations ok)
postalCode	Σ	0..1	string	Postal code for area Example General: 9132
country	Σ	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: Iso3166-1-2 (required)
period	Σ	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
total		1..1	Money	Total GFE Charges
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Claim.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Claim.type	extensible	Pattern Value: estimate-summary http://hl7.org/fhir/ValueSet/claim-type From the FHIR Standard
Claim.use	required	Pattern Value: predetermination http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
Claim.provider.extension:dataAbsentReason.value[x]	required	Pattern Value: not-applicable http://hl7.org/fhir/ValueSet/data-absent-reason From the FHIR Standard
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.related.relationship	example	ExampleRelatedClaimRelationshipCodes http://hl7.org/fhir/ValueSet/related-claim-relationship From the FHIR Standard
Claim.payee.type	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
Claim.careTeam.role	required	PCTCareTeamRoleVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:attending.role	required	Pattern Value: attending http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:attending.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:operating.role	required	Pattern Value: operating http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:operating.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:rendering.role	required	Pattern Value: rendering http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:rendering.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:referring.role	required	Pattern Value: referring http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS From this IG
Claim.careTeam:referring.qualification	required	USCoreProviderRoleNucc http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.supportingInfo.category	example	ClaimInformationCategoryCodes http://hl7.org/fhir/ValueSet/claim-informationcategory From the FHIR Standard
Claim.supportingInfo.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard
Claim.supportingInfo.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard
Claim.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard
Claim.diagnosis.type	required	DiagnosisTypeCodes http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:principal.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:principal.type	required	Pattern Value: principal http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:principal.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:principal.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:admitting.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:admitting.type	required	Pattern Value: admitting http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:admitting.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:admitting.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:patientReasonForVisit.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:patientReasonForVisit.type	required	Pattern Value: patientreasonforvisit http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:patientReasonForVisit.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:patientReasonForVisit.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:externalcauseofinjury.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:externalcauseofinjury.type	required	Pattern Value: externalcauseofinjury http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:externalcauseofinjury.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:externalcauseofinjury.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.diagnosis:other.diagnosis[x]	required	PCTDiagnosticCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes From this IG
Claim.diagnosis:other.type	required	Pattern Value: secondary http://terminology.hl7.org/ValueSet/diagnosistype
Claim.diagnosis:other.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis:other.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.procedure.type	required	PCTProcedureTypeVS http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure.procedure[x]	example	ICD-10ProcedureCodes http://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard
Claim.procedure:principal.type	required	Pattern Value: principal http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:principal.procedure[x]	required	ICD10ProcedureCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes From this IG
Claim.procedure:anesthesiaRelated.type	required	Pattern Value: procedureRequiringAnesthesia http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:anesthesiaRelated.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.procedure:other.type	required	Pattern Value: other http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS From this IG
Claim.procedure:other.procedure[x]	required	PCTProcedureSurgicalCodes http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes From this IG
Claim.accident.type	extensible	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|3.0.0
Claim.accident.location[x].use	required	AddressUse http://hl7.org/fhir/ValueSet/address-use|4.0.1 From the FHIR Standard
Claim.accident.location[x].type	required	AddressType http://hl7.org/fhir/ValueSet/address-type|4.0.1 From the FHIR Standard
Claim.accident.location[x].country	required	Iso3166-1-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 From the FHIR Standard
Claim.item.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
Claim.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
Claim.item.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place From the FHIR Standard
Claim.item.bodySite	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth From the FHIR Standard
Claim.item.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface From the FHIR Standard
Claim.item.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.detail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
Claim.item.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.detail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
Claim.item.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.detail.subDetail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
Claim.item.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.detail.subDetail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Claim	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	error	Claim	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	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Claim

Summary

Mandatory: 3 elements(15 nested mandatory elements)
Must-Support: 22 elements
Prohibited: 15 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)
• PCT Organization (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization)
• PCT Practitioner (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner)
• PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
• http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
• http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.careTeam
• The element 1 is sliced based on the value of Claim.diagnosis
• The element 1 is sliced based on the value of Claim.procedure

Maturity: 1