## Profile Comparison between http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional vs http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional

Left: | PCT Good Faith Estimate Professional (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional)
Right: | PCT Good Faith Estimate Professional (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional)

### Messages

Error | StructureDefinition.version | Values for version differ: '1.0.0' vs '2.0.1'
Information | StructureDefinition.date | Values for date differ: '2023-03-30T13:34:22+00:00' vs '2026-03-26T13:47:00+00:00'
Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 International - Financial Management Work Group' vs 'HL7 International / Financial Management'
Information | Claim.language | Example/preferred bindings differ at Claim.language using binding from PCTGFEProfessional
Information | Claim.extension | Element minimum cardinalities differ: '1' vs '0'
Information | Claim.insurer | Element minimum cardinalities differ: '1' vs '0'
Error | Claim.insurer | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]])
Error | Claim.provider | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner]])
Error | Claim.payee.party | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]])
Error | Claim.careTeam.provider | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]])
Information | Claim.diagnosis | Element minimum cardinalities differ: '1' vs '0'

### Metadata

Name | Value | Comments
--- | --- | ---
abstract | false |
baseDefinition | http://hl7.org/fhir/StructureDefinition/Claim |
copyright |  |
date | 2023-03-30T13:34:22+00:00 | 2026-03-26T13:47:00+00:00 | Values Differ
description | PCT Good Faith Estimate Professional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for a professional GFE submission. | PCT Good Faith Estimate Professional is a profile for an professional provider to capture estimation for items and services for the patient or, optionally, to submit to a payer (for patients using insurance). If submitting to a payer, this includes the data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for a professional GFE submission. | Values Differ
experimental |  |
fhirVersion | 4.0.1 |
jurisdiction |  |
jurisdiction[0] | urn:iso:std:iso:3166#US |
kind | resource |
name | PCTGFEProfessional |
publisher | HL7 International - Financial Management Work Group | HL7 International / Financial Management | Values Differ
purpose |  |
status | active |
title | PCT Good Faith Estimate Professional |
type | Claim |
url | http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional |
version | 1.0.0 | 2.0.1 | Values Differ

### Structure

Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments
--- | --- | --- | --- | --- | --- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization |
id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact |
meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
language |  | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
|  | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
| Example/preferred bindings differ at Claim.language using binding from PCTGFEProfessional
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements |
contained |  | 0..* | Resource | Contained, inline Resources |  | 0..* | Resource | Contained, inline Resources |
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url | Element minimum cardinalities differ: '1' vs '0'
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored |
Slices for identifier |  | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by pattern:type |  | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by value:type |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. |
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"professional"}]} | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"professional"}]} |
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. |  | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. |
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination |
patient | Σ | 1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services | Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | The recipient of the products and services |
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim | Σ | 0..1 | Period | Relevant time frame for the claim |
created | Σ | 1..1 | dateTime | Resource creation date | Σ | 1..1 | dateTime | Resource creation date |
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim |
insurer | Σ | 1..1 | Reference(PCT Organization) | Target | Σ | 0..1 | Reference(PCT Organization) | Target | Element minimum cardinalities differ: '1' vs '0' Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]])
provider | Σ | 1..1 | Reference(PCT Organization | PCT Practitioner) | Billing provider - party responsible for the GFE | Σ | 1..1 | Reference(PCT Organization | PCT Practitioner) | Billing provider - party responsible for the GFE | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner]])
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL |
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). |
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource |
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ?? (required) | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ?? (required) |
fundsReserve |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). |
related |  | 0..* | BackboneElement | Prior or corollary claims |  | 0..* | BackboneElement | Prior or corollary claims |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
claim |  | 0..1 | Reference(Claim) | Reference to the related claim |  | 0..1 | Reference(Claim) | Reference to the related claim |
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. |
reference |  | 0..1 | Identifier | File or case reference |  | 0..1 | Identifier | File or case reference |
prescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products |
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller |
payee | S | 0..1 | BackboneElement | Recipient of benefits payable | S | 0..1 | BackboneElement | Recipient of benefits payable |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
type |  | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. |  | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. |
party |  | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference |  | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]])
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL |
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). |
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource |
facility |  | 0..1 | Reference(Location) | Servicing facility |  | 0..1 | Reference(Location) | Servicing facility |
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:role |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Order of care team |  | 1..1 | positiveInt | Order of care team |
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]])
responsible |  | 0..1 | boolean | Indicator of the lead practitioner |  | 0..1 | boolean | Indicator of the lead practitioner |
role |  | 1..1 | CodeableConcept | Function within the team Binding: ?? (required) |  | 1..1 | CodeableConcept | Function within the team Binding: ?? (required) |
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (required) |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (required) |
Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Information instance identifier |  | 1..1 | positiveInt | Information instance identifier |
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) |
code |  | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. |  | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. |
timing[x] |  | 0..1 | date, Period | When it occurred |  | 0..1 | date, Period | When it occurred |
value[x] |  | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided |  | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. |  | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. |
Slices for diagnosis | S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type | S | 0..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by value:type | Element minimum cardinalities differ: '1' vs '0'
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier |  | 1..1 | positiveInt | Diagnosis instance identifier |
diagnosis[x] |  | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. |  | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. |
type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required) | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required) |
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. |  | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. |
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. |  | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. |
Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by value:type |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Procedure instance identifier |  | 1..1 | positiveInt | Procedure instance identifier |
type | S | 0..* | CodeableConcept | Category of Procedure Binding: ?? (required) | S | 0..* | CodeableConcept | Category of Procedure Binding: ?? (required) |
date |  | 0..1 | dateTime | When the procedure was performed |  | 0..1 | dateTime | When the procedure was performed |
procedure[x] |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. |  | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
insurance | Σ | 1..* | BackboneElement | Patient insurance information | Σ | 1..* | BackboneElement | Patient insurance information |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier | Σ | 1..1 | positiveInt | Insurance instance identifier |
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication | Σ | 1..1 | boolean | Coverage to be used for adjudication |
identifier |  | 0..1 | Identifier | Pre-assigned Claim number |  | 0..1 | Identifier | Pre-assigned Claim number |
coverage | Σ | 1..1 | Reference(PCT Coverage) | Insurance information | Σ | 1..1 | Reference(PCT Coverage) | Insurance information |
id |  |  |  |  |  | 0..1 | string | Unique id for inter-element referencing | Added this element
Slices for extension |  |  |  |  |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | Added this element
reference |  |  |  |  | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL | Added this element
type |  |  |  |  | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Added this element
identifier |  |  |  |  | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Added this element
display |  |  |  |  | Σ | 0..1 | string | Text alternative for the resource | Added this element
businessArrangement |  | 0..1 | string | Additional provider contract number |  | 0..1 | string | Additional provider contract number |
preAuthRef |  | 0..2 | string | Prior authorization reference number |  | 0..2 | string | Prior authorization reference number |
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results |  | 0..1 | Reference(ClaimResponse) | Adjudication results |
accident |  | 0..1 | BackboneElement | Details of the event |  | 0..1 | BackboneElement | Details of the event |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
date |  | 1..1 | date | When the incident occurred |  | 1..1 | date | When the incident occurred |
type |  | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. |  | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. |
location[x] |  | 0..1 | Address | Where the event occurred |  | 0..1 | Address | Where the event occurred |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: ?? (required): The use of an address. Example General: home | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: ?? (required): The use of an address. Example General: home |
type | Σ | 0..1 | code | postal | physical | both Binding: ?? (required): The type of an address (physical / postal). Example General: both | Σ | 0..1 | code | postal | physical | both Binding: ?? (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 | 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 | 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 | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon |
district | Σ | 0..1 | string | District name (aka county) Example General: Madison | Σ | 0..1 | string | District name (aka county) Example General: Madison |
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok) | Σ | 0..1 | string | Sub-unit of country (abbreviations ok) |
postalCode | Σ | 0..1 | string | Postal code for area Example General: 9132 | 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: ?? (required) | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: ?? (required) |
period | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"} | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"} |
item |  | 1..50 | BackboneElement | Product or service provided |  | 1..50 | BackboneElement | Product or service provided |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Item instance identifier |  | 1..1 | positiveInt | Item instance identifier |
careTeamSequence | S | 0..* | positiveInt | Applicable careTeam members | S | 0..* | positiveInt | Applicable careTeam members |
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses |  | 0..* | positiveInt | Applicable diagnoses |
procedureSequence |  | 0..* | positiveInt | Applicable procedures |  | 0..* | positiveInt | Applicable procedures |
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information |  | 0..* | positiveInt | Applicable exception and supporting information |
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |
category |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) |
id |  |  |  |  |  | 0..1 | string | Unique id for inter-element referencing | Added this element
Slices for extension |  |  |  |  |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | Added this element
coding |  |  |  |  | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display | Added this element
text |  |  |  |  | Σ | 0..1 | string | Plain text representation of the concept | Added this element
modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: ?? (required) | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: ?? (required) |
id |  |  |  |  |  | 0..1 | string | Unique id for inter-element referencing | Added this element
Slices for extension |  |  |  |  |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | Added this element
coding |  |  |  |  | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display | Added this element
text |  |  |  |  | Σ | 0..1 | string | Plain text representation of the concept | Added this element
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
serviced[x] | S | 1..1 | date, Period | This is the planned or estimated date(s)s of service | S | 1..1 | date, Period | This is the planned or estimated date(s)s of service |
Slices for location[x] |  | 1..1 | CodeableConcept | Place of service or where product was supplied Slice: Unordered, Closed by type:$this Binding: ?? (example): Place of service: pharmacy, school, prison, etc. |  | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: ?? (required) |
quantity |  | 1..1 | ?? | Count of products or services |  | 1..1 | ?? | Count of products or services |
unitPrice |  | 1..1 | Money | Fee, charge or cost per item |  | 1..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 1..1 | Money | Total charge amount for the service line |  | 1..1 | Money | Total charge amount for the service line |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. |  | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. |
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. |  | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. |
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item |  | 0..* | Reference(Encounter) | Encounters related to this billed item |
detail | S | 0..* | BackboneElement | Drug Identification Information | S | 0..* | BackboneElement | Drug Identification Information |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Item instance identifier |  | 1..1 | positiveInt | Item instance identifier |
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |
category |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) |
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
quantity | S | 0..1 | ?? | Count of products or services | S | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
subDetail |  | 0..* | BackboneElement | Product or service provided |  | 0..* | BackboneElement | Product or service provided |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Item instance identifier |  | 1..1 | positiveInt | Item instance identifier |
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. |
category |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |  | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. |
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. |
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
quantity |  | 0..1 | ?? | Count of products or services |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
udi |  | 0..* | Reference(Device) | Unique device identifier |  | 0..* | Reference(Device) | Unique device identifier |
total |  | 1..1 | Money | Total GFE Charges Submitted |  | 1..1 | Money | Total GFE Charges Submitted |
Documentation for this format