Intersection of http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional and http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional

This is the set of resources that conform to both PCT Good Faith Estimate Institutional (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional) and PCT Good Faith Estimate Institutional (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional).

Structure

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*		Claim, Pre-determination or Pre-authorization
Claim.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
Claim.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
Claim.contained		0..*	Resource	Contained, inline Resources
Claim.extension		1..*	Extension	Extension
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier		1..*	Identifier	Business Identifier for claim
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim.
Claim.subType		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode.
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient	Σ This element is included in summaries.	1..1	Reference(HRex Patient Demographics | #sd-24-hrex-patient-demographics-us-core-patient)	The recipient of the products and services
Claim.billablePeriod	S This element must be supported. Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
Claim.created	Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
Claim.insurer	Σ This element is included in summaries.	1..1		Target
Claim.provider	Σ This element is included in summaries.	1..1		Billing provider - party responsible for the GFE
Claim.provider.extension		1..*	Extension	Extension
Claim.provider.reference	Σ This element is included in summaries.	0..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
Claim.provider.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.provider.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ?? (required)
Claim.fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related		0..*	BackboneElement	Prior or corollary claims
Claim.related.extension		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim		0..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship		0..1	CodeableConcept	How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim.
Claim.related.reference		0..1	Identifier	File or case reference
Claim.prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
Claim.originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
Claim.payee	S This element must be supported.	0..1	BackboneElement	Recipient of benefits payable
Claim.payee.extension		0..*	Extension	Additional content defined by implementations
Claim.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.payee.type		1..1	CodeableConcept	Category of recipient Binding: ?? (example): A code for the party to be reimbursed.
Claim.payee.party		0..1		Recipient reference
Claim.referral		0..1	Reference(ServiceRequest)	Treatment referral
Claim.referral.extension		1..*	Extension	Extension
Claim.referral.reference	Σ This element is included in summaries.	0..1	string	Literal reference, Relative, internal or absolute URL
Claim.referral.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
Claim.referral.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.referral.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.facility		0..1	Reference(Location)	Servicing facility
Claim.careTeam	S This element must be supported.	0..*	BackboneElement	Members of the care team
Claim.careTeam.extension		0..*	Extension	Additional content defined by implementations
Claim.careTeam.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.careTeam.sequence		1..1	positiveInt	Order of care team
Claim.careTeam.provider		1..1		Practitioner or organization
Claim.careTeam.responsible		0..1	boolean	Indicator of the lead practitioner
Claim.careTeam.role		1..1	CodeableConcept	Function within the team Binding: ?? (required)
Claim.careTeam.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ?? (required)
Claim.supportingInfo	S This element must be supported.	1..*	BackboneElement	Supporting information
Claim.supportingInfo.extension		0..*	Extension	Additional content defined by implementations
Claim.supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ?? (extensible)
Claim.supportingInfo.code		0..1	CodeableConcept	Type of information Binding: ?? (example): The valuset used for additional information codes.
Claim.supportingInfo.timing[x]		0..1		When it occurred
Claim.supportingInfo.timing[x].timingDate			date
Claim.supportingInfo.timing[x].timingPeriod			Period
Claim.supportingInfo.value[x]		0..1		Data to be provided
Claim.supportingInfo.value[x].valueBoolean			boolean
Claim.supportingInfo.value[x].valueString			string
Claim.supportingInfo.value[x].valueQuantity			Quantity
Claim.supportingInfo.value[x].valueAttachment			Attachment
Claim.supportingInfo.value[x].valueReference			Reference(Resource)
Claim.supportingInfo.reason		0..1	CodeableConcept	Explanation for the information Binding: ?? (example): Reason codes for the missing teeth.
Claim.diagnosis	S This element must be supported.	1..*	BackboneElement	Pertinent diagnosis information
Claim.diagnosis.extension		0..*	Extension	Additional content defined by implementations
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]		1..1		Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept			CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference			Reference(Condition)
Claim.diagnosis.type	S This element must be supported.	0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ?? (required)
Claim.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission.
Claim.diagnosis.packageCode		0..1	CodeableConcept	Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis.
Claim.procedure	S This element must be supported.	0..*	BackboneElement	Clinical procedures performed
Claim.procedure.extension		1..*	Extension	Extension
Claim.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier
Claim.procedure.type	S This element must be supported.	0..*	CodeableConcept	Category of Procedure Binding: ?? (required)
Claim.procedure.date		0..1	dateTime	When the procedure was performed
Claim.procedure.procedure[x]		1..1		Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept			CodeableConcept
Claim.procedure.procedure[x].procedureReference			Reference(Procedure)
Claim.procedure.udi		0..*	Reference(Device)	Unique device identifier
Claim.insurance	Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(PCT Coverage | #sd-46-davinci-pct-coverage-davinci-pct-coverage)	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..1	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident		0..1	BackboneElement	Details of the event
Claim.accident.extension		0..*	Extension	Additional content defined by implementations
Claim.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.accident.date		1..1	date	When the incident occurred
Claim.accident.type		0..1	CodeableConcept	The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x]		0..1	Address	Where the event occurred
Claim.accident.location[x].extension		0..*	Extension	Additional content defined by implementations
Claim.accident.location[x].use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	home | work | temp | old | billing - purpose of this address Binding: ?? (required): The use of an address. Example General: home
Claim.accident.location[x].type	Σ This element is included in summaries.	0..1	code	postal | physical | both Binding: ?? (required): The type of an address (physical / postal). Example General: both
Claim.accident.location[x].text	Σ This element is included in summaries.	0..1	string	Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
Claim.accident.location[x].line	Σ This element is included in summaries.	0..*	string	Street name, number, direction & P.O. Box etc. Example General: 137 Nowhere Street
Claim.accident.location[x].city	Σ This element is included in summaries.	0..1	string	Name of city, town etc. Example General: Erewhon
Claim.accident.location[x].district	Σ This element is included in summaries.	0..1	string	District name (aka county) Example General: Madison
Claim.accident.location[x].state	Σ This element is included in summaries.	0..1	string	Sub-unit of country (abbreviations ok)
Claim.accident.location[x].postalCode	Σ This element is included in summaries.	0..1	string	Postal code for area Example General: 9132
Claim.accident.location[x].country	Σ This element is included in summaries.	0..1	string	Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: ?? (required)
Claim.accident.location[x].period	Σ This element is included in summaries.	0..1	Period	Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
Claim.item		1..999	BackboneElement	Product or service provided
Claim.item.extension		1..*	Extension	Extension
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.careTeamSequence		0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information
Claim.item.revenue		1..1	CodeableConcept	Revenue or cost center code - must provide a value for the Institutional case Binding: ?? (required)
Claim.item.category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required)
Claim.item.modifier	S This element must be supported.	0..4	CodeableConcept	Product or service billing modifiers Binding: ?? (required)
Claim.item.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
Claim.item.serviced[x]	S This element must be supported.	1..1		This is the planned or estimated date(s)s of service
Claim.item.serviced[x].servicedDate			date
Claim.item.serviced[x].servicedPeriod			Period
Claim.item.location[x]		0..1		Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConcept			CodeableConcept
Claim.item.location[x].locationAddress			Address
Claim.item.location[x].locationReference			Reference(Location)
Claim.item.quantity		1..1	?? , ??	Count of products or services
Claim.item.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor
Claim.item.net		1..1	Money	Total charge amount for the service line
Claim.item.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail	S This element must be supported.	0..*	BackboneElement	Drug Identification Information
Claim.item.detail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required)
Claim.item.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
Claim.item.detail.quantity	S This element must be supported.	0..1	?? , ??	Count of products or services
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		0..1	Money	Total item cost
Claim.item.detail.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity		0..1	?? , ??	Count of products or services
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.total		1..1	Money	Total GFE Charges Submitted
Documentation for this format