Patient Cost Transparency Implementation Guide
2.0.1 - STU 2

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 2.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

## Resource Profile: PCT Good Faith Estimate Institutional

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional | Version: 2.0.1
Standards status: Trial-use | Maturity Level: 2 | Computable Name: PCTGFEInstitutional
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.12

PCT Good Faith Estimate Institutional is a profile for an institutional 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 for a payer to process and create an Advanced EOB. This profile is used for an institutional GFE submission.

#### Notes on Fields

- The estimated service date, when available at the header level, is placed in Claim.billablePeriod. If the estimated date of service is available at the line level is placed in Claim.item.serviced[x].
- diagnosis:principal - If Diagnosis code(s) is known, it is important that it be shared in the GFE through the Claim.diagnosis:principal or additional diagnosis data elements particularly when the GFE is being sent to a payer for an insured patient. Payers very often need the diagnosis to be able to provide an estimate. Without the diagnosis, payers may assume the service is diagnostic and thus the patient responsibility may be higher or not covered at all than the diagnosis, such as for preventative services, would otherwise indicate. It is understood that in certain situations, such as scheduled services or GFE requests prior to orders, diagnosis is not needed or may not yet be known. However, when it is known, it is important that this information be shared to ensure the best possible estimate is provided to the patient.

#### Examples of .providerEventMethodology usage examples below:

##### Example 1 – A provider is offering both a surgical and a drug therapy-based option to the patient. The provider can add text such as "Surgical care option" and "Drug therapy option" to the Good Faith Estimate (GFE) so that the patient could easily understand the options without having to understand different CPT codes.

##### Example 2 – A provider added services to a previously submitted GFE. They would be able to add "Added physical therapist on Sep 18, ignore estimates submitted on Sep 17".

Usages:

- Use this Profile: PCT GFE Bundle
- Examples for this Profile: Claim/PCT-GFE-Institutional-1 and Claim/PCT-GFE-Institutional-MRI
- CapabilityStatements using this Profile: Patient Cost Transparency Implementation Guide Payer Capability Statement

You can also check for usages in the FHIR IG Statistics

Changes since version 1.1.0:

- The resource metadata has changed (description)
- The data elements list has changed
- One or more text definitions, invariants or bindings have changed

### 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:gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information. URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
extension:providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier |  | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by value:type
identifier:PLAC |  | 1..1 | Identifier | Provider Assigned Identifier for GFE Claim
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. 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/v2-0203
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC
display |  | 1..1 | string | Representation defined by the system Fixed Value: Placer Identifier
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | S Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ | 1..1 | string | The value that is unique Example General: 123456
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://terminology.hl7.org/CodeSystem/claim-type
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: institutional
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 | S Σ | 0..1 | Period | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
created | Σ | 1..1 | dateTime | Resource creation date
insurer | Σ | 0..1 | Reference(PCT Organization) | Target
provider | Σ | 1..1 | Reference(PCT Organization) | Billing provider - party responsible for the GFE
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:providerTaxonomy |  | 1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible)
extension:consentForBalanceBilling | S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
payee | S | 0..1 | BackboneElement | Recipient of benefits payable
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient 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
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 supportingInfo | S | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible)
supportingInfo:typeOfBill | S | 1..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: typeofbill
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
code |  | 1..1 | CodeableConcept | Type of information Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
supportingInfo:serviceFacility | S | 0..1 | BackboneElement | Service Facility
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility
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 value[x] |  | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Closed by type:$this
value[x]:valueReference |  | 1..1 | Reference(PCT Organization) | Data to be provided
supportingInfo:drg | S | 0..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drg
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
code |  | 0..1 | CodeableConcept | Type of information Binding: US Claim DRG Codes (required)
supportingInfo:pointoforigin | S | 0..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pointoforigin
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
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Point Of Origin (required)
supportingInfo:admtype | S | 0..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admtype
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
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Priority (Type) of Admission or Visit (required)
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: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
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | code | Coverage may be not applicable if estimate is for self-pay or uninsured URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
preAuthRef |  | 0..1 | string | Prior authorization reference number
item |  | 1..999 | BackboneElement | Product or service provided
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
extension:ProviderEventMethodology | S | 0..1 | string | Provider Event Methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 1..1 | CodeableConcept | Revenue or cost center code - must provide a value for the Institutional case Binding: PCT GFE NUBC Revenue Value Set (required)
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required)
coding | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required)
coding | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
serviced[x] | S | 1..1 |  | This is the planned or estimated date(s)s of service
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
Slices for location[x] |  | 0..1 |  | Place of service or where product was supplied Slice: Unordered, Open by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
location[x]:locationCodeableConcept | S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required)
quantity |  | 1..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 1..1 | Money | Total charge amount for the service line
detail | S | 0..* | BackboneElement | Drug Identification Information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
total |  | 1..1 | Money | Total GFE Charges Submitted
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.identifier:PLAC.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Claim.identifier:PLAC.​type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:attending.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:attending.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:operating.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:rendering.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:referring.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.supportingInfo.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​code | Base | required | PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:serviceFacility.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​code | Base | required | US Claim DRG Codes | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​code | Base | required | NUBC Point Of Origin | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​code | Base | required | NUBC Priority (Type) of Admission or Visit | 📦2.0.1 | This IG
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:principal.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure:principal.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:other.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.item.revenue | Base | required | PCT GFE NUBC Revenue Value Set | 📦2.0.1 | This IG
Claim.item.productOrService | Base | required | Claim Medical Product or Service Value Set | 📦2.0.1 | This IG
Claim.item.modifier | Base | required | PCT GFE Item CPT - HCPCS Value Set | 📦2.0.1 | This IG
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x]:locationCodeableConcept | Base | required | PCT GFE CMS Place of Service Value Set | 📦2.0.1 | This IG
Claim.item.detail.productOrService | Base | required | PCT GFE Item NDC Value Set | 📦2.0.1 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
pct-cpt-display | error | Claim.item.productOrService.coding, Claim.item.modifier.coding | CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) | `system = 'http://www.ama-assn.org/go/cpt' implies display.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:gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information. URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
extension:providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
Slices for identifier |  | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by value:type
identifier:PLAC |  | 1..1 | Identifier | Provider Assigned Identifier for GFE Claim
type |  | 1..1 | CodeableConcept | Description of identifier 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/v2-0203
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC
display |  | 1..1 | string | Representation defined by the system Fixed Value: Placer Identifier
system | S | 0..1 | uri | The namespace for the identifier value
value |  | 1..1 | string | The value that is unique
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://terminology.hl7.org/CodeSystem/claim-type
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: institutional
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 | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
insurer |  | 0..1 | Reference(PCT Organization) | Target
provider |  | 1..1 | Reference(PCT Organization) | Billing provider - party responsible for the GFE
extension |  | 1..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:providerTaxonomy |  | 1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible)
extension:consentForBalanceBilling | S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
priority |  | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
payee | S | 0..1 | BackboneElement | Recipient of benefits payable
party |  | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference
referral |  |  |  |
extension |  | 1..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:referralNumber |  | 1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
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
Slices for supportingInfo | S | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible)
supportingInfo:typeOfBill | S | 1..1 | BackboneElement | Supporting information
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: typeofbill
code |  | 1..1 | CodeableConcept | Type of information Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
supportingInfo:serviceFacility | S | 0..1 | BackboneElement | Service Facility
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility
Slices for value[x] |  | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Open by type:$this
value[x]:valueReference |  | 1..1 | Reference(PCT Organization) | Data to be provided
supportingInfo:drg | S | 0..1 | BackboneElement | Supporting information
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drg
code |  | 0..1 | CodeableConcept | Type of information Binding: US Claim DRG Codes (required)
supportingInfo:pointoforigin | S | 0..1 | BackboneElement | Supporting information
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pointoforigin
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Point Of Origin (required)
supportingInfo:admtype | S | 0..1 | BackboneElement | Supporting information
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admtype
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Priority (Type) of Admission or Visit (required)
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: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
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | code | Coverage may be not applicable if estimate is for self-pay or uninsured URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
preAuthRef |  | 0..1 | string | Prior authorization reference number
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 |  | 1..999 | BackboneElement | Product or service provided
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
extension:ProviderEventMethodology | S | 0..1 | string | Provider Event Methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
revenue |  | 1..1 | CodeableConcept | Revenue or cost center code - must provide a value for the Institutional case Binding: PCT GFE NUBC Revenue Value Set (required)
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required)
coding | C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required)
coding | C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
serviced[x] | S | 1..1 | date, Period | This is the planned or estimated date(s)s of service
Slices for location[x] |  | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Slice: Unordered, Open by type:$this
location[x]:locationCodeableConcept | S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required)
quantity |  | 1..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 1..1 | Money | Total charge amount for the service line
detail | S | 0..* | BackboneElement | Drug Identification Information
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
total |  | 1..1 | Money | Total GFE Charges Submitted
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.supportingInfo.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​code | Base | required | PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​code | Base | required | US Claim DRG Codes | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​code | Base | required | NUBC Point Of Origin | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​code | Base | required | NUBC Priority (Type) of Admission or Visit | 📦2.0.1 | This IG
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.accident.location[x].​country | Base | required | Iso 3166 Part 1: 2 Letter Codes | 📦4.0.1 | FHIR Std.
Claim.item.revenue | Base | required | PCT GFE NUBC Revenue Value Set | 📦2.0.1 | This IG
Claim.item.productOrService | Base | required | Claim Medical Product or Service Value Set | 📦2.0.1 | This IG
Claim.item.modifier | Base | required | PCT GFE Item CPT - HCPCS Value Set | 📦2.0.1 | This IG
Claim.item.location[x]:locationCodeableConcept | Base | required | PCT GFE CMS Place of Service Value Set | 📦2.0.1 | This IG
Claim.item.detail.productOrService | Base | required | PCT GFE Item NDC Value Set | 📦2.0.1 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
pct-cpt-display | error | Claim.item.productOrService.coding, Claim.item.modifier.coding | CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) | `system = 'http://www.ama-assn.org/go/cpt' implies display.exists()`

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:gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information. URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
extension:providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier |  | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by value:type
identifier:PLAC |  | 1..1 | Identifier | Provider Assigned Identifier for GFE Claim
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 | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. 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/v2-0203
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC
display |  | 1..1 | string | Representation defined by the system Fixed Value: Placer Identifier
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | S Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ | 1..1 | string | The value that is unique Example General: 123456
period | Σ | 0..1 | Period | Time period when id is/was valid for use
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text)
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://terminology.hl7.org/CodeSystem/claim-type
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: institutional
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
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
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 | S Σ | 0..1 | Period | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
created | Σ | 1..1 | dateTime | Resource creation date
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim
insurer | Σ | 0..1 | Reference(PCT Organization) | Target
provider | Σ | 1..1 | Reference(PCT Organization) | Billing provider - party responsible for the GFE
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:providerTaxonomy |  | 1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible)
extension:consentForBalanceBilling | S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
reference | 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: ResourceType (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
display | Σ | 0..1 | string | Text alternative for the resource
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
fundsReserve |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
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
prescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller
payee | S | 0..1 | BackboneElement | Recipient of benefits payable
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
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:referralNumber |  | 1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
reference | 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: ResourceType (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
display | Σ | 0..1 | string | Text alternative for the resource
facility |  | 0..1 | Reference(Location) | Servicing facility
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 supportingInfo | S | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo: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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible)
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:typeOfBill | S | 1..1 | BackboneElement | Supporting 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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: typeofbill
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
code |  | 1..1 | CodeableConcept | Type of information Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:serviceFacility | S | 0..1 | BackboneElement | Service Facility
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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility
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
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
Slices for value[x] |  | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Closed by type:$this
value[x]:valueReference |  | 1..1 | Reference(PCT Organization) | Data to be provided
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:drg | S | 0..1 | BackboneElement | Supporting 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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drg
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
code |  | 0..1 | CodeableConcept | Type of information Binding: US Claim DRG Codes (required)
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:pointoforigin | S | 0..1 | BackboneElement | Supporting 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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pointoforigin
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
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Point Of Origin (required)
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:admtype | S | 0..1 | BackboneElement | Supporting 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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admtype
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
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Priority (Type) of Admission or Visit (required)
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
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: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
id |  | 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
extension:dataAbsentReason | S | 0..1 | code | Coverage may be not applicable if estimate is for self-pay or uninsured URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
reference | 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: ResourceType (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
display | Σ | 0..1 | string | Text alternative for the resource
businessArrangement |  | 0..1 | string | Additional provider contract number
preAuthRef |  | 0..1 | string | Prior authorization reference 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"}
item |  | 1..999 | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
extension:ProviderEventMethodology | S | 0..1 | string | Provider Event Methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
careTeamSequence |  | 0..* | positiveInt | Applicable careTeam members
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses
procedureSequence |  | 0..* | positiveInt | Applicable procedures
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information
revenue |  | 1..1 | CodeableConcept | Revenue or cost center code - must provide a value for the Institutional case Binding: PCT GFE NUBC Revenue Value Set (required)
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
text | Σ | 0..1 | string | Plain text representation of the concept
modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
text | Σ | 0..1 | string | Plain text representation of the concept
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] | S | 1..1 |  | This is the planned or estimated date(s)s of service
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
Slices for location[x] |  | 0..1 |  | Place of service or where product was supplied Slice: Unordered, Open by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
location[x]:locationCodeableConcept | S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required)
quantity |  | 1..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 1..1 | Money | Total charge amount for the service line
udi |  | 0..* | Reference(Device) | Unique device identifier
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item
detail | S | 0..* | BackboneElement | Drug Identification 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 | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required)
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
subDetail |  | 0..* | BackboneElement | Product or service provided
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 | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
total |  | 1..1 | Money | Total GFE Charges Submitted
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Claim.identifier:PLAC.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Claim.identifier:PLAC.​type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.subType | Base | example | Example Claim SubType Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.provider.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.fundsReserve | Base | example | FundsReserve | 📍4.0.1 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.referral.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:attending.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:attending.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:operating.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:operating.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:rendering.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:rendering.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:referring.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:referring.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.supportingInfo.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo.​code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:typeOfBill.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​code | Base | required | PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:serviceFacility.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:serviceFacility.​code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:serviceFacility.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:drg.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​code | Base | required | US Claim DRG Codes | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:pointoforigin.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​code | Base | required | NUBC Point Of Origin | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:admtype.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​code | Base | required | NUBC Priority (Type) of Admission or Visit | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:principal.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:principal.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:admitting.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:admitting.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:patientReasonForVisit.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:patientReasonForVisit.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:externalcauseofinjury.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:externalcauseofinjury.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:other.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:other.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure:principal.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:other.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.insurance.coverage.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Claim.accident.type | Base | extensible | ActIncidentCode | 📍3.0.0 | THO v6.5
Claim.accident.location[x].​use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Claim.accident.location[x].​type | Base | required | AddressType | 📍4.0.1 | FHIR Std.
Claim.accident.location[x].​country | Base | required | Iso 3166 Part 1: 2 Letter Codes | 📦4.0.1 | FHIR Std.
Claim.item.revenue | Base | required | PCT GFE NUBC Revenue Value Set | 📦2.0.1 | This IG
Claim.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.productOrService | Base | required | Claim Medical Product or Service Value Set | 📦2.0.1 | This IG
Claim.item.modifier | Base | required | PCT GFE Item CPT - HCPCS Value Set | 📦2.0.1 | This IG
Claim.item.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x]:locationCodeableConcept | Base | required | PCT GFE CMS Place of Service Value Set | 📦2.0.1 | This IG
Claim.item.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std.
Claim.item.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.productOrService | Base | required | PCT GFE Item NDC Value Set | 📦2.0.1 | This IG
Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
pct-cpt-display | error | Claim.item.productOrService.coding, Claim.item.modifier.coding | CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) | `system = 'http://www.ama-assn.org/go/cpt' implies display.exists()`

This structure is derived from Claim

Summary

Mandatory: 17 elements(17 nested mandatory elements)
Must-Support: 38 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/gfeServiceLinkingInfo
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
- http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.identifier
- The element 1 is sliced based on the value of Claim.careTeam
- The element 1 is sliced based on the value of Claim.supportingInfo
- The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
- The element 1 is sliced based on the value of Claim.diagnosis
- The element 1 is sliced based on the value of Claim.procedure
- The element 1 is sliced based on the value of Claim.item.location[x]

Maturity: 2

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:gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information. URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
extension:providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier |  | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by value:type
identifier:PLAC |  | 1..1 | Identifier | Provider Assigned Identifier for GFE Claim
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. 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/v2-0203
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC
display |  | 1..1 | string | Representation defined by the system Fixed Value: Placer Identifier
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | S Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ | 1..1 | string | The value that is unique Example General: 123456
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://terminology.hl7.org/CodeSystem/claim-type
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: institutional
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 | S Σ | 0..1 | Period | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
created | Σ | 1..1 | dateTime | Resource creation date
insurer | Σ | 0..1 | Reference(PCT Organization) | Target
provider | Σ | 1..1 | Reference(PCT Organization) | Billing provider - party responsible for the GFE
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:providerTaxonomy |  | 1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible)
extension:consentForBalanceBilling | S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
payee | S | 0..1 | BackboneElement | Recipient of benefits payable
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient 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
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 supportingInfo | S | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible)
supportingInfo:typeOfBill | S | 1..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: typeofbill
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
code |  | 1..1 | CodeableConcept | Type of information Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
supportingInfo:serviceFacility | S | 0..1 | BackboneElement | Service Facility
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility
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 value[x] |  | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Closed by type:$this
value[x]:valueReference |  | 1..1 | Reference(PCT Organization) | Data to be provided
supportingInfo:drg | S | 0..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drg
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
code |  | 0..1 | CodeableConcept | Type of information Binding: US Claim DRG Codes (required)
supportingInfo:pointoforigin | S | 0..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pointoforigin
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
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Point Of Origin (required)
supportingInfo:admtype | S | 0..1 | BackboneElement | Supporting information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admtype
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
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Priority (Type) of Admission or Visit (required)
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: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
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | code | Coverage may be not applicable if estimate is for self-pay or uninsured URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
preAuthRef |  | 0..1 | string | Prior authorization reference number
item |  | 1..999 | BackboneElement | Product or service provided
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
extension:ProviderEventMethodology | S | 0..1 | string | Provider Event Methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 1..1 | CodeableConcept | Revenue or cost center code - must provide a value for the Institutional case Binding: PCT GFE NUBC Revenue Value Set (required)
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required)
coding | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required)
coding | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
serviced[x] | S | 1..1 |  | This is the planned or estimated date(s)s of service
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
Slices for location[x] |  | 0..1 |  | Place of service or where product was supplied Slice: Unordered, Open by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
location[x]:locationCodeableConcept | S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required)
quantity |  | 1..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 1..1 | Money | Total charge amount for the service line
detail | S | 0..* | BackboneElement | Drug Identification Information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
total |  | 1..1 | Money | Total GFE Charges Submitted
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.identifier:PLAC.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Claim.identifier:PLAC.​type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:attending.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:attending.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:operating.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:rendering.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:referring.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.supportingInfo.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​code | Base | required | PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:serviceFacility.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​code | Base | required | US Claim DRG Codes | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​code | Base | required | NUBC Point Of Origin | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​code | Base | required | NUBC Priority (Type) of Admission or Visit | 📦2.0.1 | This IG
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:principal.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure:principal.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:other.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.item.revenue | Base | required | PCT GFE NUBC Revenue Value Set | 📦2.0.1 | This IG
Claim.item.productOrService | Base | required | Claim Medical Product or Service Value Set | 📦2.0.1 | This IG
Claim.item.modifier | Base | required | PCT GFE Item CPT - HCPCS Value Set | 📦2.0.1 | This IG
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x]:locationCodeableConcept | Base | required | PCT GFE CMS Place of Service Value Set | 📦2.0.1 | This IG
Claim.item.detail.productOrService | Base | required | PCT GFE Item NDC Value Set | 📦2.0.1 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
pct-cpt-display | error | Claim.item.productOrService.coding, Claim.item.modifier.coding | CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) | `system = 'http://www.ama-assn.org/go/cpt' implies display.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:gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information. URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
extension:providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
Slices for identifier |  | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by value:type
identifier:PLAC |  | 1..1 | Identifier | Provider Assigned Identifier for GFE Claim
type |  | 1..1 | CodeableConcept | Description of identifier 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/v2-0203
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC
display |  | 1..1 | string | Representation defined by the system Fixed Value: Placer Identifier
system | S | 0..1 | uri | The namespace for the identifier value
value |  | 1..1 | string | The value that is unique
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://terminology.hl7.org/CodeSystem/claim-type
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: institutional
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 | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
insurer |  | 0..1 | Reference(PCT Organization) | Target
provider |  | 1..1 | Reference(PCT Organization) | Billing provider - party responsible for the GFE
extension |  | 1..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:providerTaxonomy |  | 1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible)
extension:consentForBalanceBilling | S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
priority |  | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
payee | S | 0..1 | BackboneElement | Recipient of benefits payable
party |  | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference
referral |  |  |  |
extension |  | 1..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:referralNumber |  | 1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
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
Slices for supportingInfo | S | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices |  |  |  | Content/Rules for all slices
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible)
supportingInfo:typeOfBill | S | 1..1 | BackboneElement | Supporting information
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: typeofbill
code |  | 1..1 | CodeableConcept | Type of information Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
supportingInfo:serviceFacility | S | 0..1 | BackboneElement | Service Facility
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility
Slices for value[x] |  | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Open by type:$this
value[x]:valueReference |  | 1..1 | Reference(PCT Organization) | Data to be provided
supportingInfo:drg | S | 0..1 | BackboneElement | Supporting information
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drg
code |  | 0..1 | CodeableConcept | Type of information Binding: US Claim DRG Codes (required)
supportingInfo:pointoforigin | S | 0..1 | BackboneElement | Supporting information
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pointoforigin
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Point Of Origin (required)
supportingInfo:admtype | S | 0..1 | BackboneElement | Supporting information
category |  | 1..1 | CodeableConcept | Classification of the supplied information 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/PCTSupportingInfoType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admtype
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Priority (Type) of Admission or Visit (required)
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: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
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason | S | 0..1 | code | Coverage may be not applicable if estimate is for self-pay or uninsured URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
preAuthRef |  | 0..1 | string | Prior authorization reference number
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 |  | 1..999 | BackboneElement | Product or service provided
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
extension:ProviderEventMethodology | S | 0..1 | string | Provider Event Methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
revenue |  | 1..1 | CodeableConcept | Revenue or cost center code - must provide a value for the Institutional case Binding: PCT GFE NUBC Revenue Value Set (required)
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required)
coding | C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required)
coding | C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
serviced[x] | S | 1..1 | date, Period | This is the planned or estimated date(s)s of service
Slices for location[x] |  | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Slice: Unordered, Open by type:$this
location[x]:locationCodeableConcept | S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required)
quantity |  | 1..1 | SimpleQuantity(4.0.1) | Count of products or services
net |  | 1..1 | Money | Total charge amount for the service line
detail | S | 0..* | BackboneElement | Drug Identification Information
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
total |  | 1..1 | Money | Total GFE Charges Submitted
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.supportingInfo.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​code | Base | required | PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​code | Base | required | US Claim DRG Codes | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​code | Base | required | NUBC Point Of Origin | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​code | Base | required | NUBC Priority (Type) of Admission or Visit | 📦2.0.1 | This IG
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.accident.location[x].​country | Base | required | Iso 3166 Part 1: 2 Letter Codes | 📦4.0.1 | FHIR Std.
Claim.item.revenue | Base | required | PCT GFE NUBC Revenue Value Set | 📦2.0.1 | This IG
Claim.item.productOrService | Base | required | Claim Medical Product or Service Value Set | 📦2.0.1 | This IG
Claim.item.modifier | Base | required | PCT GFE Item CPT - HCPCS Value Set | 📦2.0.1 | This IG
Claim.item.location[x]:locationCodeableConcept | Base | required | PCT GFE CMS Place of Service Value Set | 📦2.0.1 | This IG
Claim.item.detail.productOrService | Base | required | PCT GFE Item NDC Value Set | 📦2.0.1 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
pct-cpt-display | error | Claim.item.productOrService.coding, Claim.item.modifier.coding | CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) | `system = 'http://www.ama-assn.org/go/cpt' implies display.exists()`

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:gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information. URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
extension:providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
Slices for identifier |  | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by value:type
identifier:PLAC |  | 1..1 | Identifier | Provider Assigned Identifier for GFE Claim
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 | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type | Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. 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/v2-0203
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: PLAC
display |  | 1..1 | string | Representation defined by the system Fixed Value: Placer Identifier
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
system | S Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value | Σ | 1..1 | string | The value that is unique Example General: 123456
period | Σ | 0..1 | Period | Time period when id is/was valid for use
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text)
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://terminology.hl7.org/CodeSystem/claim-type
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: institutional
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
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
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 | S Σ | 0..1 | Period | Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
created | Σ | 1..1 | dateTime | Resource creation date
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim
insurer | Σ | 0..1 | Reference(PCT Organization) | Target
provider | Σ | 1..1 | Reference(PCT Organization) | Billing provider - party responsible for the GFE
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:providerTaxonomy |  | 1..1 | CodeableConcept | Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy Binding: US Core Provider Role (NUCC) (extensible)
extension:consentForBalanceBilling | S | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
reference | 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: ResourceType (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
display | Σ | 0..1 | string | Text alternative for the resource
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
fundsReserve |  | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
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
prescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products
originalPrescription |  | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller
payee | S | 0..1 | BackboneElement | Recipient of benefits payable
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
type |  | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party |  | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:referralNumber |  | 1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
reference | 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: ResourceType (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
display | Σ | 0..1 | string | Text alternative for the resource
facility |  | 0..1 | Reference(Location) | Servicing facility
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 supportingInfo | S | 1..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category
supportingInfo: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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible)
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:typeOfBill | S | 1..1 | BackboneElement | Supporting 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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: typeofbill
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
code |  | 1..1 | CodeableConcept | Type of information Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:serviceFacility | S | 0..1 | BackboneElement | Service Facility
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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility
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
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
Slices for value[x] |  | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Closed by type:$this
value[x]:valueReference |  | 1..1 | Reference(PCT Organization) | Data to be provided
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:drg | S | 0..1 | BackboneElement | Supporting 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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drg
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
code |  | 0..1 | CodeableConcept | Type of information Binding: US Claim DRG Codes (required)
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:pointoforigin | S | 0..1 | BackboneElement | Supporting 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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pointoforigin
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
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Point Of Origin (required)
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:admtype | S | 0..1 | BackboneElement | Supporting 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 | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set (extensible) 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/PCTSupportingInfoType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admtype
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
code |  | 0..1 | CodeableConcept | Type of information Binding: NUBC Priority (Type) of Admission or Visit (required)
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
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: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
id |  | 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
extension:dataAbsentReason | S | 0..1 | code | Coverage may be not applicable if estimate is for self-pay or uninsured URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
reference | 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: ResourceType (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
display | Σ | 0..1 | string | Text alternative for the resource
businessArrangement |  | 0..1 | string | Additional provider contract number
preAuthRef |  | 0..1 | string | Prior authorization reference 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"}
item |  | 1..999 | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
extension:ProviderEventMethodology | S | 0..1 | string | Provider Event Methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
careTeamSequence |  | 0..* | positiveInt | Applicable careTeam members
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses
procedureSequence |  | 0..* | positiveInt | Applicable procedures
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information
revenue |  | 1..1 | CodeableConcept | Revenue or cost center code - must provide a value for the Institutional case Binding: PCT GFE NUBC Revenue Value Set (required)
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Claim Medical Product or Service Value Set (required)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
text | Σ | 0..1 | string | Plain text representation of the concept
modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ C | 0..* | Coding | Code defined by a terminology system Constraints: pct-cpt-display
text | Σ | 0..1 | string | Plain text representation of the concept
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] | S | 1..1 |  | This is the planned or estimated date(s)s of service
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
Slices for location[x] |  | 0..1 |  | Place of service or where product was supplied Slice: Unordered, Open by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
location[x]:locationCodeableConcept | S | 0..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required)
quantity |  | 1..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 1..1 | Money | Total charge amount for the service line
udi |  | 0..* | Reference(Device) | Unique device identifier
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item
detail | S | 0..* | BackboneElement | Drug Identification 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 | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required)
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
subDetail |  | 0..* | BackboneElement | Product or service provided
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 | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity(4.0.1) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
total |  | 1..1 | Money | Total GFE Charges Submitted
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Claim.identifier:PLAC.​use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std.
Claim.identifier:PLAC.​type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.subType | Base | example | Example Claim SubType Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.provider.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.fundsReserve | Base | example | FundsReserve | 📍4.0.1 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.referral.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:attending.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:attending.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:operating.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:operating.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:rendering.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:rendering.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:referring.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:referring.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.supportingInfo.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo.​code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:typeOfBill.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​code | Base | required | PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:typeOfBill.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:serviceFacility.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:serviceFacility.​code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:serviceFacility.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:drg.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​code | Base | required | US Claim DRG Codes | 📦2.0.1 | This IG
Claim.supportingInfo:drg.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:pointoforigin.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​code | Base | required | NUBC Point Of Origin | 📦2.0.1 | This IG
Claim.supportingInfo:pointoforigin.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo:admtype.​category | Base | extensible | PCT Supporting Info Type Value Set | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​code | Base | required | NUBC Priority (Type) of Admission or Visit | 📦2.0.1 | This IG
Claim.supportingInfo:admtype.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:principal.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:principal.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:admitting.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:admitting.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:patientReasonForVisit.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:patientReasonForVisit.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:externalcauseofinjury.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:externalcauseofinjury.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:other.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:other.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure:principal.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:other.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.insurance.coverage.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Claim.accident.type | Base | extensible | ActIncidentCode | 📍3.0.0 | THO v6.5
Claim.accident.location[x].​use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Claim.accident.location[x].​type | Base | required | AddressType | 📍4.0.1 | FHIR Std.
Claim.accident.location[x].​country | Base | required | Iso 3166 Part 1: 2 Letter Codes | 📦4.0.1 | FHIR Std.
Claim.item.revenue | Base | required | PCT GFE NUBC Revenue Value Set | 📦2.0.1 | This IG
Claim.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.productOrService | Base | required | Claim Medical Product or Service Value Set | 📦2.0.1 | This IG
Claim.item.modifier | Base | required | PCT GFE Item CPT - HCPCS Value Set | 📦2.0.1 | This IG
Claim.item.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x]:locationCodeableConcept | Base | required | PCT GFE CMS Place of Service Value Set | 📦2.0.1 | This IG
Claim.item.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std.
Claim.item.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.productOrService | Base | required | PCT GFE Item NDC Value Set | 📦2.0.1 | This IG
Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
pct-cpt-display | error | Claim.item.productOrService.coding, Claim.item.modifier.coding | CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) | `system = 'http://www.ama-assn.org/go/cpt' implies display.exists()`

This structure is derived from Claim

Summary

Mandatory: 17 elements(17 nested mandatory elements)
Must-Support: 38 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/gfeServiceLinkingInfo
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
- http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.identifier
- The element 1 is sliced based on the value of Claim.careTeam
- The element 1 is sliced based on the value of Claim.supportingInfo
- The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
- The element 1 is sliced based on the value of Claim.diagnosis
- The element 1 is sliced based on the value of Claim.procedure
- The element 1 is sliced based on the value of Claim.item.location[x]

Maturity: 2

Other representations of profile: CSV, Excel, Schematron