Patient Cost Transparency Implementation Guide
2.0.2 - STU 2 United States of America flag

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.2 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: 2.0.2
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:

You can also check for usages in the FHIR IG Statistics

Changes since version 1.1.0:

  • The data elements list has changed
  • One or more text definitions, invariants or bindings have changed (description, Claim.extension:providerEventMethodology, Claim.extension:gfeDisclaimer, Claim.supportingInfo:typeOfBill, Claim.supportingInfo:drg, Claim.supportingInfo:pointoforigin, Claim.supportingInfo:admtype, Claim.diagnosis:principal)

    • Formal Views of Profile Content

    Description Differentials, Snapshots, and other representations.

    NameFlagsCard.TypeDescription & Constraints    Filter: doco
    Claim 0..* Claim Claim, Pre-determination or Pre-authorization
    Claim.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
    Claim.Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for extension.extension:gfeServiceLinkingInfo This element must be supported. 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    Claim.Slices for extension.extension:providerEventMethodology This element must be supported. 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.Slices for extension.extension:gfeDisclaimer This element must be supported. 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
    Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
    Claim.Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    Claim.Slices for identifier.identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    Claim.Slices for identifier.identifier:PLAC.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    Claim.Slices for identifier.identifier:PLAC.type This element is included in summaries. 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: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
      "code" : "PLAC"
    }
  ]
}
    Claim.Slices for identifier.identifier:PLAC.system This element must be supported. This element is included in summaries. 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    Claim.Slices for identifier.identifier:PLAC.value This element is included in summaries. 1..1 string The value that is unique
    Example General: 123456
    Claim.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    Claim.type This element is included in summaries. 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional"
    }
  ]
}
    Claim.use This element is included in summaries. 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
    Required Pattern: predetermination (extensions allowed)
    Claim.patient This element is included in summaries. 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    Claim.billablePeriod This element must be supported. 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 This element is included in summaries. 1..1 dateTime Resource creation date
    Claim.insurer This element is included in summaries. 0..1 Reference(PCT Organization) Target
    Claim.provider This element is included in summaries. 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    Claim.provider.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.provider.Slices for extension.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)
    Claim.provider.Slices for extension.extension:consentForBalanceBilling This element must be supported. 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
    Claim.payee.modifierExtension This element is a modifier element. 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: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    Claim.payee.party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    Claim.Slices for careTeam This element must be supported. 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for careTeam.careTeam:All Slices Content/Rules for all slices
    Claim.Slices for careTeam.careTeam:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:All Slices.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:All Slices.provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:All Slices.role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Claim.Slices for careTeam.careTeam:All Slices.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    Claim.Slices for careTeam.careTeam:attending This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:attending.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:attending.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:attending.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:attending.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "attending"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:attending.qualification 1..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for careTeam.careTeam:operating This element must be supported. 0..2 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:operating.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:operating.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:operating.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:operating.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "operating"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:rendering This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:rendering.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:rendering.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:rendering.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:rendering.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "rendering"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:referring This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:referring.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:referring.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:referring.provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:referring.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "referring"
    }
  ]
}
    Claim.Slices for supportingInfo This element must be supported. 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for supportingInfo.supportingInfo:All Slices Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill This element must be supported. 1..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "typeofbill"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility This element must be supported. 0..1 BackboneElement Service Facility
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "servicefacility"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Closed by type:$this
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x].value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:drg This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:drg.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:drg.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:drg.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "drg"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:drg.code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "pointoforigin"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    Claim.Slices for supportingInfo.supportingInfo:admtype This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:admtype.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:admtype.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:admtype.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "admtype"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:admtype.code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    Claim.Slices for diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for diagnosis.diagnosis:All Slices Content/Rules for all slices
    Claim.Slices for diagnosis.diagnosis:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:All Slices.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x] 1..1 Nature of illness or problem
    Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x].diagnosisCodeableConcept CodeableConcept
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x].diagnosisReference Reference(Condition)
    Claim.Slices for diagnosis.diagnosis:All Slices.type This element must be supported. 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal This element must be supported. 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    Claim.Slices for diagnosis.diagnosis:principal.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:principal.sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for diagnosis.diagnosis:principal.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:admitting This element must be supported. 0..1 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:admitting.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:admitting.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:admitting.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:admitting.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "admitting"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit This element must be supported. 0..3 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "patientreasonforvisit"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury This element must be supported. 0..12 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "externalcauseofinjury"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:other This element must be supported. 0..24 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:other.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:other.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:other.diagnosis[x] This element must be supported. 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:other.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "secondary"
    }
  ]
}
    Claim.Slices for procedure This element must be supported. 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for procedure.procedure:All Slices Content/Rules for all slices
    Claim.Slices for procedure.procedure:All Slices.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:All Slices.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:All Slices.sequence 1..1 positiveInt Procedure instance identifier
    Claim.Slices for procedure.procedure:All Slices.type This element must be supported. 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    Claim.Slices for procedure.procedure:All Slices.procedure[x] 1..1 Specific clinical procedure
    Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
    Claim.Slices for procedure.procedure:All Slices.procedure[x].procedureCodeableConcept CodeableConcept
    Claim.Slices for procedure.procedure:All Slices.procedure[x].procedureReference Reference(Procedure)
    Claim.Slices for procedure.procedure:principal This element must be supported. 0..1 BackboneElement Principal clinical procedure performed
    Claim.Slices for procedure.procedure:principal.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:principal.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:principal.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:principal.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:principal.sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for procedure.procedure:principal.type 1..1 CodeableConcept Category of Procedure
    Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for procedure.procedure:principal.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    Claim.Slices for procedure.procedure:other This element must be supported. 0..24 BackboneElement Clinical procedures performed
    Claim.Slices for procedure.procedure:other.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:other.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:other.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:other.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:other.sequence 1..1 positiveInt Procedure instance identifier
    Claim.Slices for procedure.procedure:other.type 1..1 CodeableConcept Category of Procedure
    Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "other"
    }
  ]
}
    Claim.Slices for procedure.procedure:other.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    Claim.insurance This element is included in summaries. 1..* BackboneElement Patient insurance information
    Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
    Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
    Claim.insurance.coverage This element is included in summaries. 1..1 Reference(PCT Coverage) Insurance information
    Claim.insurance.coverage.Slices for extension Content/Rules for all slices
    Claim.insurance.coverage.Slices for extension.extension:dataAbsentReason This element must be supported. 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)
    Claim.insurance.preAuthRef 0..1 string Prior authorization reference number
    Claim.item 1..999 BackboneElement Product or service provided
    Claim.item.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.item.Slices for extension.extension:gfeBillingProviderLineItemCtrlNum This element must be supported. 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    Claim.item.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.item.Slices for extension.extension:ProviderEventMethodology This element must be supported. 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.item.modifierExtension This element is a modifier element. 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.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)
    Claim.item.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    Claim.item.productOrService.coding This element is included in summaries. C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.modifier This element must be supported. 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    Claim.item.modifier.coding This element is included in summaries. C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.serviced[x] 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.Slices for location[x] 0..1 Place of service or where product was supplied
    Slice: Unordered, Closed by type:$this
    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
    Slicing Note: Other type slices that contain no new information are not shown in this view
    Claim.item.Slices for location[x].locationCodeableConcept CodeableConcept
    Claim.item.Slices for location[x].locationAddress Address
    Claim.item.Slices for location[x].locationReference Reference(Location)
    Claim.item.Slices for location[x].location[x]:locationCodeableConcept This element must be supported. 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    Claim.item.quantity C 1..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    Claim.item.net 1..1 Money Total charge amount for the service line
    Claim.item.detail This element must be supported. 0..* BackboneElement Drug Identification Information
    Claim.item.detail.modifierExtension This element is a modifier element. 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.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    Claim.item.detail.quantity This element must be supported. C 0..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    Claim.total 1..1 Money Total GFE Charges Submitted

    doco 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 📦2.0.2 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:attending.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:attending.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:operating.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:rendering.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:referring.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.2 This IG
    Claim.supportingInfo:typeOfBill.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.2 This IG
    Claim.supportingInfo:serviceFacility.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:drg.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.2 This IG
    Claim.supportingInfo:pointoforigin.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.2 This IG
    Claim.supportingInfo:admtype.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.2 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 v7.1
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:principal.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:admitting.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:patientReasonForVisit.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:externalcauseofinjury.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:other.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.2 This IG
    Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.2 This IG
    Claim.procedure:other.​type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.2 This IG
    Claim.item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.2 This IG
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.2 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.2 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 📦2.0.2 This IG
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.2 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()

    This structure is derived from Claim

    NameFlagsCard.TypeDescription & Constraints    Filter: doco
    Claim Claim
    Claim.Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for extension.extension:gfeServiceLinkingInfo This element must be supported. 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    Claim.Slices for extension.extension:providerEventMethodology This element must be supported. 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.Slices for extension.extension:gfeDisclaimer This element must be supported. 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
    Claim.Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    Claim.Slices for identifier.identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    Claim.Slices for identifier.identifier:PLAC.type 1..1 CodeableConcept Description of identifier
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
      "code" : "PLAC"
    }
  ]
}
    Claim.Slices for identifier.identifier:PLAC.system This element must be supported. 0..1 uri The namespace for the identifier value
    Claim.Slices for identifier.identifier:PLAC.value 1..1 string The value that is unique
    Claim.type 1..1 CodeableConcept Category or discipline
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional"
    }
  ]
}
    Claim.use 1..1 code claim | preauthorization | predetermination
    Required Pattern: predetermination (extensions allowed)
    Claim.patient 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    Claim.billablePeriod This element must be supported. 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
    Claim.insurer 0..1 Reference(PCT Organization) Target
    Claim.provider 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    Claim.provider.extension 1..* Extension Extension
    Claim.provider.Slices for extension Content/Rules for all slices
    Claim.provider.Slices for extension.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)
    Claim.provider.Slices for extension.extension:consentForBalanceBilling This element must be supported. 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    Claim.priority 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
    Claim.payee.party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    Claim.referral
    Claim.referral.extension 1..* Extension Extension
    Claim.referral.Slices for extension Content/Rules for all slices
    Claim.referral.Slices for extension.extension:referralNumber 1..1 string Referral Number
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
    Claim.Slices for careTeam This element must be supported. 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role
    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for careTeam.careTeam:All Slices Content/Rules for all slices
    Claim.Slices for careTeam.careTeam:All Slices.provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:All Slices.role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Claim.Slices for careTeam.careTeam:All Slices.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    Claim.Slices for careTeam.careTeam:attending This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:attending.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:attending.role 0..1 CodeableConcept Function within the team
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "attending"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:attending.qualification 1..1 CodeableConcept Practitioner credential or specialization
    Claim.Slices for careTeam.careTeam:operating This element must be supported. 0..2 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:operating.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:operating.role 0..1 CodeableConcept Function within the team
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "operating"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:rendering This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:rendering.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:rendering.role 0..1 CodeableConcept Function within the team
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "rendering"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:referring This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:referring.role 0..1 CodeableConcept Function within the team
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "referring"
    }
  ]
}
    Claim.Slices for supportingInfo This element must be supported. 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category
    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for supportingInfo.supportingInfo:All Slices Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill This element must be supported. 1..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "typeofbill"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility This element must be supported. 0..1 BackboneElement Service Facility
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "servicefacility"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Open by type:$this
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x].value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:drg This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:drg.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "drg"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:drg.code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "pointoforigin"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    Claim.Slices for supportingInfo.supportingInfo:admtype This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:admtype.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "admtype"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:admtype.code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    Claim.Slices for diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type
    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for diagnosis.diagnosis:All Slices Content/Rules for all slices
    Claim.Slices for diagnosis.diagnosis:All Slices.type This element must be supported. 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal This element must be supported. 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    Claim.Slices for diagnosis.diagnosis:principal.sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for diagnosis.diagnosis:principal.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:admitting This element must be supported. 0..1 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:admitting.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:admitting.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "admitting"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit This element must be supported. 0..3 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "patientreasonforvisit"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury This element must be supported. 0..12 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "externalcauseofinjury"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:other This element must be supported. 0..24 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:other.diagnosis[x] This element must be supported. 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:other.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "secondary"
    }
  ]
}
    Claim.Slices for procedure This element must be supported. 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type
    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for procedure.procedure:All Slices Content/Rules for all slices
    Claim.Slices for procedure.procedure:All Slices.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:All Slices.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:All Slices.type This element must be supported. 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    Claim.Slices for procedure.procedure:principal This element must be supported. 0..1 BackboneElement Principal clinical procedure performed
    Claim.Slices for procedure.procedure:principal.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:principal.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:principal.sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for procedure.procedure:principal.type 1..1 CodeableConcept Category of Procedure
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for procedure.procedure:principal.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    Claim.Slices for procedure.procedure:other This element must be supported. 0..24 BackboneElement Clinical procedures performed
    Claim.Slices for procedure.procedure:other.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:other.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:other.type 1..1 CodeableConcept Category of Procedure
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "other"
    }
  ]
}
    Claim.Slices for procedure.procedure:other.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    Claim.insurance
    Claim.insurance.coverage 1..1 Reference(PCT Coverage) Insurance information
    Claim.insurance.coverage.Slices for extension Content/Rules for all slices
    Claim.insurance.coverage.Slices for extension.extension:dataAbsentReason This element must be supported. 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)
    Claim.insurance.preAuthRef 0..1 string Prior authorization reference number
    Claim.accident
    Claim.accident.location[x] 0..1 Address Where the event occurred
    Claim.accident.location[x].country 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
    Binding: Iso3166-1-2 (required)
    Claim.item 1..999 BackboneElement Product or service provided
    Claim.item.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.item.Slices for extension.extension:gfeBillingProviderLineItemCtrlNum This element must be supported. 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    Claim.item.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.item.Slices for extension.extension:ProviderEventMethodology This element must be supported. 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.item.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)
    Claim.item.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    Claim.item.productOrService.coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.modifier This element must be supported. 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    Claim.item.modifier.coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.serviced[x] This element must be supported. 1..1 date, Period This is the planned or estimated date(s)s of service
    Claim.item.Slices for location[x] 0..1 CodeableConcept, Address, Reference(Location) Place of service or where product was supplied
    Slice: Unordered, Open by type:$this
    Slicing Note: Other type slices that contain no new information are not shown in this view
    Claim.item.Slices for location[x].location[x]:locationCodeableConcept This element must be supported. 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    Claim.item.quantity 1..1 SimpleQuantity(4.0.1) Count of products or services
    Claim.item.net 1..1 Money Total charge amount for the service line
    Claim.item.detail This element must be supported. 0..* BackboneElement Drug Identification Information
    Claim.item.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    Claim.item.detail.quantity This element must be supported. 0..1 SimpleQuantity(4.0.1) Count of products or services
    Claim.total 1..1 Money Total GFE Charges Submitted

    doco 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 📦2.0.2 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 📦2.0.2 This IG
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.2 This IG
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.2 This IG
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.2 This IG
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.2 This IG
    Claim.diagnosis.type Base required Diagnosis Type Codes 📦1.0.0 THO v7.1
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.2 This IG
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.2 This IG
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.2 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 📦2.0.2 This IG
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.2 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.2 This IG
    Claim.item.location[x]:locationCodeableConcept Base required PCT GFE CMS Place of Service Value Set 📦2.0.2 This IG
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.2 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()
    NameFlagsCard.TypeDescription & Constraints    Filter: doco
    Claim 0..* Claim Claim, Pre-determination or Pre-authorization
    Claim.id This element is included in summaries. 0..1 id Logical id of this artifact
    Claim.meta This element is included in summaries. 0..1 Meta Metadata about the resource
    Claim.implicitRules This element is a modifier element. 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: CommonLanguages (preferred): A human language.
    Additional BindingsPurpose
    AllLanguages 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.Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for extension.extension:gfeServiceLinkingInfo This element must be supported. 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    Claim.Slices for extension.extension:providerEventMethodology This element must be supported. 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.Slices for extension.extension:gfeDisclaimer This element must be supported. 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
    Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
    Claim.Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    Claim.Slices for identifier.identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    Claim.Slices for identifier.identifier:PLAC.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for identifier.identifier:PLAC.extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.Slices for identifier.identifier:PLAC.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    Claim.Slices for identifier.identifier:PLAC.type This element is included in summaries. 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: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
      "code" : "PLAC"
    }
  ]
}
    Claim.Slices for identifier.identifier:PLAC.system This element must be supported. This element is included in summaries. 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    Claim.Slices for identifier.identifier:PLAC.value This element is included in summaries. 1..1 string The value that is unique
    Example General: 123456
    Claim.Slices for identifier.identifier:PLAC.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
    Claim.Slices for identifier.identifier:PLAC.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
    Claim.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    Claim.type This element is included in summaries. 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional"
    }
  ]
}
    Claim.subType 0..1 CodeableConcept More granular claim type
    Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
    Claim.use This element is included in summaries. 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
    Required Pattern: predetermination (extensions allowed)
    Claim.patient This element is included in summaries. 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    Claim.billablePeriod This element must be supported. 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 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 This element is included in summaries. 0..1 Reference(PCT Organization) Target
    Claim.provider This element is included in summaries. 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    Claim.provider.id 0..1 string Unique id for inter-element referencing
    Claim.provider.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.provider.Slices for extension.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)
    Claim.provider.Slices for extension.extension:consentForBalanceBilling This element must be supported. 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    Claim.provider.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
    Claim.provider.type This element is included in summaries. 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).
    Claim.provider.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known
    Claim.provider.display This element is included in summaries. 0..1 string Text alternative for the resource
    Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    Claim.fundsReserve 0..1 CodeableConcept For whom to reserve funds
    Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
    Claim.related 0..* BackboneElement Prior or corollary claims
    Claim.related.id 0..1 string Unique id for inter-element referencing
    Claim.related.extension 0..* Extension Additional content defined by implementations
    Claim.related.modifierExtension This element is a modifier element. 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: ExampleRelatedClaimRelationshipCodes (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 This element must be supported. 0..1 BackboneElement Recipient of benefits payable
    Claim.payee.id 0..1 string Unique id for inter-element referencing
    Claim.payee.extension 0..* Extension Additional content defined by implementations
    Claim.payee.modifierExtension This element is a modifier element. 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: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    Claim.payee.party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    Claim.referral 0..1 Reference(ServiceRequest) Treatment referral
    Claim.referral.id 0..1 string Unique id for inter-element referencing
    Claim.referral.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.referral.Slices for extension.extension:referralNumber 1..1 string Referral Number
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
    Claim.referral.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
    Claim.referral.type This element is included in summaries. 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).
    Claim.referral.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known
    Claim.referral.display This element is included in summaries. 0..1 string Text alternative for the resource
    Claim.facility 0..1 Reference(Location) Servicing facility
    Claim.Slices for careTeam This element must be supported. 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for careTeam.careTeam:All Slices Content/Rules for all slices
    Claim.Slices for careTeam.careTeam:All Slices.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:All Slices.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:All Slices.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:All Slices.provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:All Slices.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:All Slices.role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Claim.Slices for careTeam.careTeam:All Slices.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    Claim.Slices for careTeam.careTeam:attending This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:attending.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:attending.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:attending.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:attending.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:attending.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:attending.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:attending.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "attending"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:attending.qualification 1..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for careTeam.careTeam:operating This element must be supported. 0..2 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:operating.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:operating.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:operating.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:operating.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:operating.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:operating.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:operating.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "operating"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:operating.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for careTeam.careTeam:rendering This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:rendering.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:rendering.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:rendering.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:rendering.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:rendering.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:rendering.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:rendering.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "rendering"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:rendering.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for careTeam.careTeam:referring This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:referring.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:referring.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:referring.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:referring.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:referring.provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:referring.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:referring.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "referring"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:referring.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for supportingInfo This element must be supported. 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for supportingInfo.supportingInfo:All Slices Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:All Slices.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:All Slices.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Claim.Slices for supportingInfo.supportingInfo:All Slices.code 0..1 CodeableConcept Type of information
    Binding: ExceptionCodes (example): The valuset used for additional information codes.
    Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:All Slices.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill This element must be supported. 1..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "typeofbill"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility This element must be supported. 0..1 BackboneElement Service Facility
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "servicefacility"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.code 0..1 CodeableConcept Type of information
    Binding: ExceptionCodes (example): The valuset used for additional information codes.
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Closed by type:$this
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x].value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:drg This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:drg.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:drg.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:drg.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:drg.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:drg.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "drg"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:drg.code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    Claim.Slices for supportingInfo.supportingInfo:drg.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:drg.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:drg.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:drg.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "pointoforigin"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:admtype This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:admtype.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:admtype.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:admtype.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:admtype.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:admtype.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "admtype"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:admtype.code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    Claim.Slices for supportingInfo.supportingInfo:admtype.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:admtype.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:admtype.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:admtype.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for diagnosis.diagnosis:All Slices Content/Rules for all slices
    Claim.Slices for diagnosis.diagnosis:All Slices.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:All Slices.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:All Slices.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x] 1..1 Nature of illness or problem
    Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x].diagnosisCodeableConcept CodeableConcept
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x].diagnosisReference Reference(Condition)
    Claim.Slices for diagnosis.diagnosis:All Slices.type This element must be supported. 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    Claim.Slices for diagnosis.diagnosis:All Slices.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:All Slices.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:principal This element must be supported. 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    Claim.Slices for diagnosis.diagnosis:principal.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:principal.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:principal.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:principal.sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for diagnosis.diagnosis:principal.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:principal.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:principal.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:admitting This element must be supported. 0..1 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:admitting.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:admitting.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:admitting.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:admitting.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:admitting.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:admitting.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "admitting"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:admitting.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:admitting.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit This element must be supported. 0..3 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "patientreasonforvisit"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury This element must be supported. 0..12 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "externalcauseofinjury"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:other This element must be supported. 0..24 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:other.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:other.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:other.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:other.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:other.diagnosis[x] This element must be supported. 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:other.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "secondary"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:other.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:other.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for procedure This element must be supported. 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for procedure.procedure:All Slices Content/Rules for all slices
    Claim.Slices for procedure.procedure:All Slices.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for procedure.procedure:All Slices.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:All Slices.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:All Slices.sequence 1..1 positiveInt Procedure instance identifier
    Claim.Slices for procedure.procedure:All Slices.type This element must be supported. 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    Claim.Slices for procedure.procedure:All Slices.date 0..1 dateTime When the procedure was performed
    Claim.Slices for procedure.procedure:All Slices.procedure[x] 1..1 Specific clinical procedure
    Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
    Claim.Slices for procedure.procedure:All Slices.procedure[x].procedureCodeableConcept CodeableConcept
    Claim.Slices for procedure.procedure:All Slices.procedure[x].procedureReference Reference(Procedure)
    Claim.Slices for procedure.procedure:All Slices.udi 0..* Reference(Device) Unique device identifier
    Claim.Slices for procedure.procedure:principal This element must be supported. 0..1 BackboneElement Principal clinical procedure performed
    Claim.Slices for procedure.procedure:principal.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for procedure.procedure:principal.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:principal.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:principal.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:principal.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:principal.sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for procedure.procedure:principal.type 1..1 CodeableConcept Category of Procedure
    Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for procedure.procedure:principal.date 0..1 dateTime When the procedure was performed
    Claim.Slices for procedure.procedure:principal.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    Claim.Slices for procedure.procedure:principal.udi 0..* Reference(Device) Unique device identifier
    Claim.Slices for procedure.procedure:other This element must be supported. 0..24 BackboneElement Clinical procedures performed
    Claim.Slices for procedure.procedure:other.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for procedure.procedure:other.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:other.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:other.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:other.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:other.sequence 1..1 positiveInt Procedure instance identifier
    Claim.Slices for procedure.procedure:other.type 1..1 CodeableConcept Category of Procedure
    Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "other"
    }
  ]
}
    Claim.Slices for procedure.procedure:other.date 0..1 dateTime When the procedure was performed
    Claim.Slices for procedure.procedure:other.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    Claim.Slices for procedure.procedure:other.udi 0..* Reference(Device) Unique device identifier
    Claim.insurance This element is included in summaries. 1..* BackboneElement Patient insurance information
    Claim.insurance.id 0..1 string Unique id for inter-element referencing
    Claim.insurance.extension 0..* Extension Additional content defined by implementations
    Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
    Claim.insurance.focal 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 This element is included in summaries. 1..1 Reference(PCT Coverage) Insurance information
    Claim.insurance.coverage.id 0..1 string Unique id for inter-element referencing
    Claim.insurance.coverage.Slices for extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.insurance.coverage.Slices for extension.extension:dataAbsentReason This element must be supported. 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)
    Claim.insurance.coverage.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
    Claim.insurance.coverage.type This element is included in summaries. 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).
    Claim.insurance.coverage.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known
    Claim.insurance.coverage.display This element is included in summaries. 0..1 string Text alternative for the resource
    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.id 0..1 string Unique id for inter-element referencing
    Claim.accident.extension 0..* Extension Additional content defined by implementations
    Claim.accident.modifierExtension This element is a modifier element. 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: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
    Claim.accident.location[x] 0..1 Address Where the event occurred
    Claim.accident.location[x].id 0..1 string Unique id for inter-element referencing
    Claim.accident.location[x].extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.accident.location[x].use This element is a modifier element. This element is included in summaries. 0..1 code home | work | temp | old | billing - purpose of this address
    Binding: AddressUse (required): The use of an address.
    Example General: home
    Claim.accident.location[x].type This element is included in summaries. 0..1 code postal | physical | both
    Binding: AddressType (required): The type of an address (physical / postal).
    Example General: both
    Claim.accident.location[x].text 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 This element is included in summaries. 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
    Claim.accident.location[x].city This element is included in summaries. 0..1 string Name of city, town etc.
    Example General: Erewhon
    Claim.accident.location[x].district This element is included in summaries. 0..1 string District name (aka county)
    Example General: Madison
    Claim.accident.location[x].state This element is included in summaries. 0..1 string Sub-unit of country (abbreviations ok)
    Claim.accident.location[x].postalCode This element is included in summaries. 0..1 string Postal code for area
    Example General: 9132
    Claim.accident.location[x].country This element is included in summaries. 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
    Binding: Iso3166-1-2 (required)
    Claim.accident.location[x].period 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.id 0..1 string Unique id for inter-element referencing
    Claim.item.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.item.Slices for extension.extension:gfeBillingProviderLineItemCtrlNum This element must be supported. 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    Claim.item.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.item.Slices for extension.extension:ProviderEventMethodology This element must be supported. 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.item.modifierExtension This element is a modifier element. 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: PCT GFE NUBC Revenue Value Set (required)
    Claim.item.category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    Claim.item.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    Claim.item.productOrService.id 0..1 string Unique id for inter-element referencing
    Claim.item.productOrService.extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.item.productOrService.coding This element is included in summaries. C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.productOrService.text This element is included in summaries. 0..1 string Plain text representation of the concept
    Claim.item.modifier This element must be supported. 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    Claim.item.modifier.id 0..1 string Unique id for inter-element referencing
    Claim.item.modifier.extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.item.modifier.coding This element is included in summaries. C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.modifier.text This element is included in summaries. 0..1 string Plain text representation of the concept
    Claim.item.programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    Claim.item.serviced[x] 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.Slices for location[x] 0..1 Place of service or where product was supplied
    Slice: Unordered, Closed by type:$this
    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
    Slicing Note: Other type slices that contain no new information are not shown in this view
    Claim.item.Slices for location[x].locationCodeableConcept CodeableConcept
    Claim.item.Slices for location[x].locationAddress Address
    Claim.item.Slices for location[x].locationReference Reference(Location)
    Claim.item.Slices for location[x].location[x]:locationCodeableConcept This element must be supported. 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    Claim.item.quantity C 1..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    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: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
    Claim.item.subSite 0..* CodeableConcept Anatomical sub-location
    Binding: SurfaceCodes (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 This element must be supported. 0..* BackboneElement Drug Identification Information
    Claim.item.detail.id 0..1 string Unique id for inter-element referencing
    Claim.item.detail.extension 0..* Extension Additional content defined by implementations
    Claim.item.detail.modifierExtension This element is a modifier element. 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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
    Claim.item.detail.category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    Claim.item.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    Claim.item.detail.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.
    Claim.item.detail.programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    Claim.item.detail.quantity This element must be supported. C 0..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    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.id 0..1 string Unique id for inter-element referencing
    Claim.item.detail.subDetail.extension 0..* Extension Additional content defined by implementations
    Claim.item.detail.subDetail.modifierExtension This element is a modifier element. 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: ExampleRevenueCenterCodes (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: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    Claim.item.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: USCLSCodes (example): Allowable service and product codes.
    Claim.item.detail.subDetail.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.
    Claim.item.detail.subDetail.programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    Claim.item.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    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

    doco 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 📦2.0.2 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:attending.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:attending.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:operating.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:operating.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:rendering.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:rendering.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:referring.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:referring.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.2 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 example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.2 This IG
    Claim.supportingInfo:typeOfBill.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:serviceFacility.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    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 example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.2 This IG
    Claim.supportingInfo:drg.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:pointoforigin.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.2 This IG
    Claim.supportingInfo:pointoforigin.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:admtype.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.2 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 v7.1
    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 📦2.0.2 This IG
    Claim.diagnosis:principal.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.diagnosis:admitting.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.diagnosis:patientReasonForVisit.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.diagnosis:externalcauseofinjury.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.diagnosis:other.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.2 This IG
    Claim.procedure:other.​type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.2 This IG
    Claim.insurance.coverage.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Claim.accident.type Base extensible ActIncidentCode 📍3.0.0 THO v7.1
    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 📦2.0.2 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 📦2.0.2 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.2 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 📦2.0.2 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 📦2.0.2 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
    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:

    Extensions

    This structure refers to these extensions:

    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

    NameFlagsCard.TypeDescription & Constraints    Filter: doco
    Claim 0..* Claim Claim, Pre-determination or Pre-authorization
    Claim.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
    Claim.Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for extension.extension:gfeServiceLinkingInfo This element must be supported. 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    Claim.Slices for extension.extension:providerEventMethodology This element must be supported. 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.Slices for extension.extension:gfeDisclaimer This element must be supported. 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
    Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
    Claim.Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    Claim.Slices for identifier.identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    Claim.Slices for identifier.identifier:PLAC.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    Claim.Slices for identifier.identifier:PLAC.type This element is included in summaries. 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: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
      "code" : "PLAC"
    }
  ]
}
    Claim.Slices for identifier.identifier:PLAC.system This element must be supported. This element is included in summaries. 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    Claim.Slices for identifier.identifier:PLAC.value This element is included in summaries. 1..1 string The value that is unique
    Example General: 123456
    Claim.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    Claim.type This element is included in summaries. 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional"
    }
  ]
}
    Claim.use This element is included in summaries. 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
    Required Pattern: predetermination (extensions allowed)
    Claim.patient This element is included in summaries. 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    Claim.billablePeriod This element must be supported. 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 This element is included in summaries. 1..1 dateTime Resource creation date
    Claim.insurer This element is included in summaries. 0..1 Reference(PCT Organization) Target
    Claim.provider This element is included in summaries. 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    Claim.provider.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.provider.Slices for extension.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)
    Claim.provider.Slices for extension.extension:consentForBalanceBilling This element must be supported. 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
    Claim.payee.modifierExtension This element is a modifier element. 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: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    Claim.payee.party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    Claim.Slices for careTeam This element must be supported. 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for careTeam.careTeam:All Slices Content/Rules for all slices
    Claim.Slices for careTeam.careTeam:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:All Slices.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:All Slices.provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:All Slices.role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Claim.Slices for careTeam.careTeam:All Slices.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    Claim.Slices for careTeam.careTeam:attending This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:attending.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:attending.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:attending.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:attending.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "attending"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:attending.qualification 1..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for careTeam.careTeam:operating This element must be supported. 0..2 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:operating.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:operating.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:operating.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:operating.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "operating"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:rendering This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:rendering.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:rendering.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:rendering.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:rendering.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "rendering"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:referring This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:referring.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:referring.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:referring.provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:referring.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "referring"
    }
  ]
}
    Claim.Slices for supportingInfo This element must be supported. 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for supportingInfo.supportingInfo:All Slices Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill This element must be supported. 1..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "typeofbill"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility This element must be supported. 0..1 BackboneElement Service Facility
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "servicefacility"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Closed by type:$this
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x].value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:drg This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:drg.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:drg.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:drg.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "drg"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:drg.code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "pointoforigin"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    Claim.Slices for supportingInfo.supportingInfo:admtype This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:admtype.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:admtype.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:admtype.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "admtype"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:admtype.code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    Claim.Slices for diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for diagnosis.diagnosis:All Slices Content/Rules for all slices
    Claim.Slices for diagnosis.diagnosis:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:All Slices.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x] 1..1 Nature of illness or problem
    Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x].diagnosisCodeableConcept CodeableConcept
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x].diagnosisReference Reference(Condition)
    Claim.Slices for diagnosis.diagnosis:All Slices.type This element must be supported. 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal This element must be supported. 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    Claim.Slices for diagnosis.diagnosis:principal.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:principal.sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for diagnosis.diagnosis:principal.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:admitting This element must be supported. 0..1 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:admitting.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:admitting.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:admitting.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:admitting.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "admitting"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit This element must be supported. 0..3 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "patientreasonforvisit"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury This element must be supported. 0..12 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "externalcauseofinjury"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:other This element must be supported. 0..24 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:other.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:other.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:other.diagnosis[x] This element must be supported. 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:other.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "secondary"
    }
  ]
}
    Claim.Slices for procedure This element must be supported. 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for procedure.procedure:All Slices Content/Rules for all slices
    Claim.Slices for procedure.procedure:All Slices.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:All Slices.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:All Slices.sequence 1..1 positiveInt Procedure instance identifier
    Claim.Slices for procedure.procedure:All Slices.type This element must be supported. 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    Claim.Slices for procedure.procedure:All Slices.procedure[x] 1..1 Specific clinical procedure
    Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
    Claim.Slices for procedure.procedure:All Slices.procedure[x].procedureCodeableConcept CodeableConcept
    Claim.Slices for procedure.procedure:All Slices.procedure[x].procedureReference Reference(Procedure)
    Claim.Slices for procedure.procedure:principal This element must be supported. 0..1 BackboneElement Principal clinical procedure performed
    Claim.Slices for procedure.procedure:principal.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:principal.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:principal.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:principal.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:principal.sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for procedure.procedure:principal.type 1..1 CodeableConcept Category of Procedure
    Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for procedure.procedure:principal.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    Claim.Slices for procedure.procedure:other This element must be supported. 0..24 BackboneElement Clinical procedures performed
    Claim.Slices for procedure.procedure:other.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:other.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:other.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:other.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:other.sequence 1..1 positiveInt Procedure instance identifier
    Claim.Slices for procedure.procedure:other.type 1..1 CodeableConcept Category of Procedure
    Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "other"
    }
  ]
}
    Claim.Slices for procedure.procedure:other.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    Claim.insurance This element is included in summaries. 1..* BackboneElement Patient insurance information
    Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
    Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
    Claim.insurance.coverage This element is included in summaries. 1..1 Reference(PCT Coverage) Insurance information
    Claim.insurance.coverage.Slices for extension Content/Rules for all slices
    Claim.insurance.coverage.Slices for extension.extension:dataAbsentReason This element must be supported. 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)
    Claim.insurance.preAuthRef 0..1 string Prior authorization reference number
    Claim.item 1..999 BackboneElement Product or service provided
    Claim.item.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.item.Slices for extension.extension:gfeBillingProviderLineItemCtrlNum This element must be supported. 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    Claim.item.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.item.Slices for extension.extension:ProviderEventMethodology This element must be supported. 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.item.modifierExtension This element is a modifier element. 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.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)
    Claim.item.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    Claim.item.productOrService.coding This element is included in summaries. C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.modifier This element must be supported. 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    Claim.item.modifier.coding This element is included in summaries. C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.serviced[x] 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.Slices for location[x] 0..1 Place of service or where product was supplied
    Slice: Unordered, Closed by type:$this
    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
    Slicing Note: Other type slices that contain no new information are not shown in this view
    Claim.item.Slices for location[x].locationCodeableConcept CodeableConcept
    Claim.item.Slices for location[x].locationAddress Address
    Claim.item.Slices for location[x].locationReference Reference(Location)
    Claim.item.Slices for location[x].location[x]:locationCodeableConcept This element must be supported. 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    Claim.item.quantity C 1..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    Claim.item.net 1..1 Money Total charge amount for the service line
    Claim.item.detail This element must be supported. 0..* BackboneElement Drug Identification Information
    Claim.item.detail.modifierExtension This element is a modifier element. 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.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    Claim.item.detail.quantity This element must be supported. C 0..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    Claim.total 1..1 Money Total GFE Charges Submitted

    doco 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 📦2.0.2 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:attending.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:attending.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:operating.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:rendering.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:referring.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.2 This IG
    Claim.supportingInfo:typeOfBill.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.2 This IG
    Claim.supportingInfo:serviceFacility.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:drg.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.2 This IG
    Claim.supportingInfo:pointoforigin.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.2 This IG
    Claim.supportingInfo:admtype.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.2 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 v7.1
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:principal.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:admitting.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:patientReasonForVisit.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:externalcauseofinjury.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:other.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.2 This IG
    Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.2 This IG
    Claim.procedure:other.​type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.2 This IG
    Claim.item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.2 This IG
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.2 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.2 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 📦2.0.2 This IG
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.2 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()

    Differential View

    This structure is derived from Claim

    NameFlagsCard.TypeDescription & Constraints    Filter: doco
    Claim Claim
    Claim.Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for extension.extension:gfeServiceLinkingInfo This element must be supported. 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    Claim.Slices for extension.extension:providerEventMethodology This element must be supported. 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.Slices for extension.extension:gfeDisclaimer This element must be supported. 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
    Claim.Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    Claim.Slices for identifier.identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    Claim.Slices for identifier.identifier:PLAC.type 1..1 CodeableConcept Description of identifier
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
      "code" : "PLAC"
    }
  ]
}
    Claim.Slices for identifier.identifier:PLAC.system This element must be supported. 0..1 uri The namespace for the identifier value
    Claim.Slices for identifier.identifier:PLAC.value 1..1 string The value that is unique
    Claim.type 1..1 CodeableConcept Category or discipline
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional"
    }
  ]
}
    Claim.use 1..1 code claim | preauthorization | predetermination
    Required Pattern: predetermination (extensions allowed)
    Claim.patient 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    Claim.billablePeriod This element must be supported. 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
    Claim.insurer 0..1 Reference(PCT Organization) Target
    Claim.provider 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    Claim.provider.extension 1..* Extension Extension
    Claim.provider.Slices for extension Content/Rules for all slices
    Claim.provider.Slices for extension.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)
    Claim.provider.Slices for extension.extension:consentForBalanceBilling This element must be supported. 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    Claim.priority 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    Claim.payee This element must be supported. 0..1 BackboneElement Recipient of benefits payable
    Claim.payee.party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    Claim.referral
    Claim.referral.extension 1..* Extension Extension
    Claim.referral.Slices for extension Content/Rules for all slices
    Claim.referral.Slices for extension.extension:referralNumber 1..1 string Referral Number
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
    Claim.Slices for careTeam This element must be supported. 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role
    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for careTeam.careTeam:All Slices Content/Rules for all slices
    Claim.Slices for careTeam.careTeam:All Slices.provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:All Slices.role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Claim.Slices for careTeam.careTeam:All Slices.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    Claim.Slices for careTeam.careTeam:attending This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:attending.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:attending.role 0..1 CodeableConcept Function within the team
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "attending"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:attending.qualification 1..1 CodeableConcept Practitioner credential or specialization
    Claim.Slices for careTeam.careTeam:operating This element must be supported. 0..2 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:operating.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:operating.role 0..1 CodeableConcept Function within the team
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "operating"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:rendering This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:rendering.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:rendering.role 0..1 CodeableConcept Function within the team
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "rendering"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:referring This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:referring.role 0..1 CodeableConcept Function within the team
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "referring"
    }
  ]
}
    Claim.Slices for supportingInfo This element must be supported. 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category
    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for supportingInfo.supportingInfo:All Slices Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill This element must be supported. 1..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "typeofbill"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility This element must be supported. 0..1 BackboneElement Service Facility
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "servicefacility"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Open by type:$this
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x].value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:drg This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:drg.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "drg"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:drg.code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "pointoforigin"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    Claim.Slices for supportingInfo.supportingInfo:admtype This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:admtype.category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "admtype"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:admtype.code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    Claim.Slices for diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type
    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for diagnosis.diagnosis:All Slices Content/Rules for all slices
    Claim.Slices for diagnosis.diagnosis:All Slices.type This element must be supported. 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal This element must be supported. 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    Claim.Slices for diagnosis.diagnosis:principal.sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for diagnosis.diagnosis:principal.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:admitting This element must be supported. 0..1 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:admitting.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:admitting.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "admitting"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit This element must be supported. 0..3 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "patientreasonforvisit"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury This element must be supported. 0..12 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "externalcauseofinjury"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:other This element must be supported. 0..24 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:other.diagnosis[x] This element must be supported. 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:other.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "secondary"
    }
  ]
}
    Claim.Slices for procedure This element must be supported. 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type
    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for procedure.procedure:All Slices Content/Rules for all slices
    Claim.Slices for procedure.procedure:All Slices.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:All Slices.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:All Slices.type This element must be supported. 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    Claim.Slices for procedure.procedure:principal This element must be supported. 0..1 BackboneElement Principal clinical procedure performed
    Claim.Slices for procedure.procedure:principal.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:principal.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:principal.sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for procedure.procedure:principal.type 1..1 CodeableConcept Category of Procedure
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for procedure.procedure:principal.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    Claim.Slices for procedure.procedure:other This element must be supported. 0..24 BackboneElement Clinical procedures performed
    Claim.Slices for procedure.procedure:other.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:other.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:other.type 1..1 CodeableConcept Category of Procedure
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "other"
    }
  ]
}
    Claim.Slices for procedure.procedure:other.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    Claim.insurance
    Claim.insurance.coverage 1..1 Reference(PCT Coverage) Insurance information
    Claim.insurance.coverage.Slices for extension Content/Rules for all slices
    Claim.insurance.coverage.Slices for extension.extension:dataAbsentReason This element must be supported. 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)
    Claim.insurance.preAuthRef 0..1 string Prior authorization reference number
    Claim.accident
    Claim.accident.location[x] 0..1 Address Where the event occurred
    Claim.accident.location[x].country 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
    Binding: Iso3166-1-2 (required)
    Claim.item 1..999 BackboneElement Product or service provided
    Claim.item.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.item.Slices for extension.extension:gfeBillingProviderLineItemCtrlNum This element must be supported. 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    Claim.item.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.item.Slices for extension.extension:ProviderEventMethodology This element must be supported. 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.item.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)
    Claim.item.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    Claim.item.productOrService.coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.modifier This element must be supported. 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    Claim.item.modifier.coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.serviced[x] This element must be supported. 1..1 date, Period This is the planned or estimated date(s)s of service
    Claim.item.Slices for location[x] 0..1 CodeableConcept, Address, Reference(Location) Place of service or where product was supplied
    Slice: Unordered, Open by type:$this
    Slicing Note: Other type slices that contain no new information are not shown in this view
    Claim.item.Slices for location[x].location[x]:locationCodeableConcept This element must be supported. 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    Claim.item.quantity 1..1 SimpleQuantity(4.0.1) Count of products or services
    Claim.item.net 1..1 Money Total charge amount for the service line
    Claim.item.detail This element must be supported. 0..* BackboneElement Drug Identification Information
    Claim.item.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    Claim.item.detail.quantity This element must be supported. 0..1 SimpleQuantity(4.0.1) Count of products or services
    Claim.total 1..1 Money Total GFE Charges Submitted

    doco 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 📦2.0.2 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 📦2.0.2 This IG
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.2 This IG
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.2 This IG
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.2 This IG
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.2 This IG
    Claim.diagnosis.type Base required Diagnosis Type Codes 📦1.0.0 THO v7.1
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.2 This IG
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.2 This IG
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.2 This IG
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.2 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 📦2.0.2 This IG
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.2 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.2 This IG
    Claim.item.location[x]:locationCodeableConcept Base required PCT GFE CMS Place of Service Value Set 📦2.0.2 This IG
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.2 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 ViewView

    NameFlagsCard.TypeDescription & Constraints    Filter: doco
    Claim 0..* Claim Claim, Pre-determination or Pre-authorization
    Claim.id This element is included in summaries. 0..1 id Logical id of this artifact
    Claim.meta This element is included in summaries. 0..1 Meta Metadata about the resource
    Claim.implicitRules This element is a modifier element. 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: CommonLanguages (preferred): A human language.
    Additional BindingsPurpose
    AllLanguages 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.Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for extension.extension:gfeServiceLinkingInfo This element must be supported. 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    Claim.Slices for extension.extension:providerEventMethodology This element must be supported. 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.Slices for extension.extension:gfeDisclaimer This element must be supported. 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
    Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
    Claim.Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    Claim.Slices for identifier.identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    Claim.Slices for identifier.identifier:PLAC.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for identifier.identifier:PLAC.extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.Slices for identifier.identifier:PLAC.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    Claim.Slices for identifier.identifier:PLAC.type This element is included in summaries. 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: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
      "code" : "PLAC"
    }
  ]
}
    Claim.Slices for identifier.identifier:PLAC.system This element must be supported. This element is included in summaries. 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    Claim.Slices for identifier.identifier:PLAC.value This element is included in summaries. 1..1 string The value that is unique
    Example General: 123456
    Claim.Slices for identifier.identifier:PLAC.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
    Claim.Slices for identifier.identifier:PLAC.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
    Claim.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    Claim.type This element is included in summaries. 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional"
    }
  ]
}
    Claim.subType 0..1 CodeableConcept More granular claim type
    Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
    Claim.use This element is included in summaries. 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
    Required Pattern: predetermination (extensions allowed)
    Claim.patient This element is included in summaries. 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    Claim.billablePeriod This element must be supported. 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 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 This element is included in summaries. 0..1 Reference(PCT Organization) Target
    Claim.provider This element is included in summaries. 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    Claim.provider.id 0..1 string Unique id for inter-element referencing
    Claim.provider.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.provider.Slices for extension.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)
    Claim.provider.Slices for extension.extension:consentForBalanceBilling This element must be supported. 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    Claim.provider.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
    Claim.provider.type This element is included in summaries. 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).
    Claim.provider.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known
    Claim.provider.display This element is included in summaries. 0..1 string Text alternative for the resource
    Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    Claim.fundsReserve 0..1 CodeableConcept For whom to reserve funds
    Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
    Claim.related 0..* BackboneElement Prior or corollary claims
    Claim.related.id 0..1 string Unique id for inter-element referencing
    Claim.related.extension 0..* Extension Additional content defined by implementations
    Claim.related.modifierExtension This element is a modifier element. 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: ExampleRelatedClaimRelationshipCodes (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 This element must be supported. 0..1 BackboneElement Recipient of benefits payable
    Claim.payee.id 0..1 string Unique id for inter-element referencing
    Claim.payee.extension 0..* Extension Additional content defined by implementations
    Claim.payee.modifierExtension This element is a modifier element. 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: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    Claim.payee.party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    Claim.referral 0..1 Reference(ServiceRequest) Treatment referral
    Claim.referral.id 0..1 string Unique id for inter-element referencing
    Claim.referral.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.referral.Slices for extension.extension:referralNumber 1..1 string Referral Number
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
    Claim.referral.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
    Claim.referral.type This element is included in summaries. 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).
    Claim.referral.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known
    Claim.referral.display This element is included in summaries. 0..1 string Text alternative for the resource
    Claim.facility 0..1 Reference(Location) Servicing facility
    Claim.Slices for careTeam This element must be supported. 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for careTeam.careTeam:All Slices Content/Rules for all slices
    Claim.Slices for careTeam.careTeam:All Slices.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:All Slices.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:All Slices.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:All Slices.provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:All Slices.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:All Slices.role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Claim.Slices for careTeam.careTeam:All Slices.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    Claim.Slices for careTeam.careTeam:attending This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:attending.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:attending.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:attending.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:attending.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:attending.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:attending.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:attending.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "attending"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:attending.qualification 1..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for careTeam.careTeam:operating This element must be supported. 0..2 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:operating.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:operating.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:operating.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:operating.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:operating.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:operating.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:operating.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "operating"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:operating.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for careTeam.careTeam:rendering This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:rendering.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:rendering.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:rendering.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:rendering.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:rendering.provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    Claim.Slices for careTeam.careTeam:rendering.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:rendering.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "rendering"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:rendering.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for careTeam.careTeam:referring This element must be supported. 0..1 BackboneElement Members of the care team
    Claim.Slices for careTeam.careTeam:referring.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for careTeam.careTeam:referring.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for careTeam.careTeam:referring.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for careTeam.careTeam:referring.sequence 1..1 positiveInt Order of care team
    Claim.Slices for careTeam.careTeam:referring.provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
    Claim.Slices for careTeam.careTeam:referring.responsible 0..1 boolean Indicator of the lead practitioner
    Claim.Slices for careTeam.careTeam:referring.role 0..1 CodeableConcept Function within the team
    Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
      "code" : "referring"
    }
  ]
}
    Claim.Slices for careTeam.careTeam:referring.qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
    Claim.Slices for supportingInfo This element must be supported. 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for supportingInfo.supportingInfo:All Slices Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:All Slices.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:All Slices.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Claim.Slices for supportingInfo.supportingInfo:All Slices.code 0..1 CodeableConcept Type of information
    Binding: ExceptionCodes (example): The valuset used for additional information codes.
    Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:All Slices.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill This element must be supported. 1..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "typeofbill"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:typeOfBill.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility This element must be supported. 0..1 BackboneElement Service Facility
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "servicefacility"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.code 0..1 CodeableConcept Type of information
    Binding: ExceptionCodes (example): The valuset used for additional information codes.
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Closed by type:$this
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x] Content/Rules for all slices
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.Slices for value[x].value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:serviceFacility.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:drg This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:drg.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:drg.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:drg.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:drg.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:drg.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "drg"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:drg.code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    Claim.Slices for supportingInfo.supportingInfo:drg.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:drg.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:drg.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:drg.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:drg.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "pointoforigin"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:pointoforigin.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for supportingInfo.supportingInfo:admtype This element must be supported. 0..1 BackboneElement Supporting information
    Claim.Slices for supportingInfo.supportingInfo:admtype.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for supportingInfo.supportingInfo:admtype.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for supportingInfo.supportingInfo:admtype.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for supportingInfo.supportingInfo:admtype.sequence 1..1 positiveInt Information instance identifier
    Claim.Slices for supportingInfo.supportingInfo:admtype.category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType",
      "code" : "admtype"
    }
  ]
}
    Claim.Slices for supportingInfo.supportingInfo:admtype.code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    Claim.Slices for supportingInfo.supportingInfo:admtype.timing[x] 0..1 When it occurred
    Claim.Slices for supportingInfo.supportingInfo:admtype.timing[x].timingDate date
    Claim.Slices for supportingInfo.supportingInfo:admtype.timing[x].timingPeriod Period
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x] 0..1 Data to be provided
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueBoolean boolean
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueString string
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueQuantity Quantity
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueAttachment Attachment
    Claim.Slices for supportingInfo.supportingInfo:admtype.value[x].valueReference Reference(Resource)
    Claim.Slices for supportingInfo.supportingInfo:admtype.reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    Claim.Slices for diagnosis This element must be supported. 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for diagnosis.diagnosis:All Slices Content/Rules for all slices
    Claim.Slices for diagnosis.diagnosis:All Slices.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:All Slices.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:All Slices.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x] 1..1 Nature of illness or problem
    Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x].diagnosisCodeableConcept CodeableConcept
    Claim.Slices for diagnosis.diagnosis:All Slices.diagnosis[x].diagnosisReference Reference(Condition)
    Claim.Slices for diagnosis.diagnosis:All Slices.type This element must be supported. 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    Claim.Slices for diagnosis.diagnosis:All Slices.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:All Slices.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:principal This element must be supported. 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    Claim.Slices for diagnosis.diagnosis:principal.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:principal.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:principal.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:principal.sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for diagnosis.diagnosis:principal.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:principal.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:principal.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:principal.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:admitting This element must be supported. 0..1 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:admitting.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:admitting.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:admitting.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:admitting.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:admitting.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:admitting.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "admitting"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:admitting.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:admitting.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit This element must be supported. 0..3 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "patientreasonforvisit"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:patientReasonForVisit.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury This element must be supported. 0..12 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "externalcauseofinjury"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:externalcauseofinjury.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for diagnosis.diagnosis:other This element must be supported. 0..24 BackboneElement Pertinent diagnosis information
    Claim.Slices for diagnosis.diagnosis:other.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for diagnosis.diagnosis:other.extension 0..* Extension Additional content defined by implementations
    Claim.Slices for diagnosis.diagnosis:other.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for diagnosis.diagnosis:other.sequence 1..1 positiveInt Diagnosis instance identifier
    Claim.Slices for diagnosis.diagnosis:other.diagnosis[x] This element must be supported. 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    Claim.Slices for diagnosis.diagnosis:other.type 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/diagnosistype",
      "code" : "secondary"
    }
  ]
}
    Claim.Slices for diagnosis.diagnosis:other.onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    Claim.Slices for diagnosis.diagnosis:other.packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    Claim.Slices for procedure This element must be supported. 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type

    Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
    Claim.Slices for procedure.procedure:All Slices Content/Rules for all slices
    Claim.Slices for procedure.procedure:All Slices.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for procedure.procedure:All Slices.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:All Slices.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:All Slices.sequence 1..1 positiveInt Procedure instance identifier
    Claim.Slices for procedure.procedure:All Slices.type This element must be supported. 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    Claim.Slices for procedure.procedure:All Slices.date 0..1 dateTime When the procedure was performed
    Claim.Slices for procedure.procedure:All Slices.procedure[x] 1..1 Specific clinical procedure
    Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
    Claim.Slices for procedure.procedure:All Slices.procedure[x].procedureCodeableConcept CodeableConcept
    Claim.Slices for procedure.procedure:All Slices.procedure[x].procedureReference Reference(Procedure)
    Claim.Slices for procedure.procedure:All Slices.udi 0..* Reference(Device) Unique device identifier
    Claim.Slices for procedure.procedure:principal This element must be supported. 0..1 BackboneElement Principal clinical procedure performed
    Claim.Slices for procedure.procedure:principal.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for procedure.procedure:principal.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:principal.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:principal.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:principal.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:principal.sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1 (extensions allowed)
    Claim.Slices for procedure.procedure:principal.type 1..1 CodeableConcept Category of Procedure
    Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "principal"
    }
  ]
}
    Claim.Slices for procedure.procedure:principal.date 0..1 dateTime When the procedure was performed
    Claim.Slices for procedure.procedure:principal.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    Claim.Slices for procedure.procedure:principal.udi 0..* Reference(Device) Unique device identifier
    Claim.Slices for procedure.procedure:other This element must be supported. 0..24 BackboneElement Clinical procedures performed
    Claim.Slices for procedure.procedure:other.id 0..1 string Unique id for inter-element referencing
    Claim.Slices for procedure.procedure:other.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.Slices for procedure.procedure:other.Slices for extension Content/Rules for all slices
    Claim.Slices for procedure.procedure:other.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.Slices for procedure.procedure:other.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.Slices for procedure.procedure:other.sequence 1..1 positiveInt Procedure instance identifier
    Claim.Slices for procedure.procedure:other.type 1..1 CodeableConcept Category of Procedure
    Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.

    Required Pattern: 
    {
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType",
      "code" : "other"
    }
  ]
}
    Claim.Slices for procedure.procedure:other.date 0..1 dateTime When the procedure was performed
    Claim.Slices for procedure.procedure:other.procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    Claim.Slices for procedure.procedure:other.udi 0..* Reference(Device) Unique device identifier
    Claim.insurance This element is included in summaries. 1..* BackboneElement Patient insurance information
    Claim.insurance.id 0..1 string Unique id for inter-element referencing
    Claim.insurance.extension 0..* Extension Additional content defined by implementations
    Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
    Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
    Claim.insurance.focal 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 This element is included in summaries. 1..1 Reference(PCT Coverage) Insurance information
    Claim.insurance.coverage.id 0..1 string Unique id for inter-element referencing
    Claim.insurance.coverage.Slices for extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.insurance.coverage.Slices for extension.extension:dataAbsentReason This element must be supported. 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)
    Claim.insurance.coverage.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
    Claim.insurance.coverage.type This element is included in summaries. 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).
    Claim.insurance.coverage.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known
    Claim.insurance.coverage.display This element is included in summaries. 0..1 string Text alternative for the resource
    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.id 0..1 string Unique id for inter-element referencing
    Claim.accident.extension 0..* Extension Additional content defined by implementations
    Claim.accident.modifierExtension This element is a modifier element. 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: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
    Claim.accident.location[x] 0..1 Address Where the event occurred
    Claim.accident.location[x].id 0..1 string Unique id for inter-element referencing
    Claim.accident.location[x].extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.accident.location[x].use This element is a modifier element. This element is included in summaries. 0..1 code home | work | temp | old | billing - purpose of this address
    Binding: AddressUse (required): The use of an address.
    Example General: home
    Claim.accident.location[x].type This element is included in summaries. 0..1 code postal | physical | both
    Binding: AddressType (required): The type of an address (physical / postal).
    Example General: both
    Claim.accident.location[x].text 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 This element is included in summaries. 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
    Claim.accident.location[x].city This element is included in summaries. 0..1 string Name of city, town etc.
    Example General: Erewhon
    Claim.accident.location[x].district This element is included in summaries. 0..1 string District name (aka county)
    Example General: Madison
    Claim.accident.location[x].state This element is included in summaries. 0..1 string Sub-unit of country (abbreviations ok)
    Claim.accident.location[x].postalCode This element is included in summaries. 0..1 string Postal code for area
    Example General: 9132
    Claim.accident.location[x].country This element is included in summaries. 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
    Binding: Iso3166-1-2 (required)
    Claim.accident.location[x].period 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.id 0..1 string Unique id for inter-element referencing
    Claim.item.Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    Claim.item.Slices for extension.extension:gfeBillingProviderLineItemCtrlNum This element must be supported. 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    Claim.item.Slices for extension.extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    Claim.item.Slices for extension.extension:ProviderEventMethodology This element must be supported. 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    Claim.item.modifierExtension This element is a modifier element. 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: PCT GFE NUBC Revenue Value Set (required)
    Claim.item.category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    Claim.item.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    Claim.item.productOrService.id 0..1 string Unique id for inter-element referencing
    Claim.item.productOrService.extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.item.productOrService.coding This element is included in summaries. C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.productOrService.text This element is included in summaries. 0..1 string Plain text representation of the concept
    Claim.item.modifier This element must be supported. 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    Claim.item.modifier.id 0..1 string Unique id for inter-element referencing
    Claim.item.modifier.extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    Claim.item.modifier.coding This element is included in summaries. C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    Claim.item.modifier.text This element is included in summaries. 0..1 string Plain text representation of the concept
    Claim.item.programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    Claim.item.serviced[x] 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.Slices for location[x] 0..1 Place of service or where product was supplied
    Slice: Unordered, Closed by type:$this
    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
    Slicing Note: Other type slices that contain no new information are not shown in this view
    Claim.item.Slices for location[x].locationCodeableConcept CodeableConcept
    Claim.item.Slices for location[x].locationAddress Address
    Claim.item.Slices for location[x].locationReference Reference(Location)
    Claim.item.Slices for location[x].location[x]:locationCodeableConcept This element must be supported. 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    Claim.item.quantity C 1..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    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: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
    Claim.item.subSite 0..* CodeableConcept Anatomical sub-location
    Binding: SurfaceCodes (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 This element must be supported. 0..* BackboneElement Drug Identification Information
    Claim.item.detail.id 0..1 string Unique id for inter-element referencing
    Claim.item.detail.extension 0..* Extension Additional content defined by implementations
    Claim.item.detail.modifierExtension This element is a modifier element. 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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
    Claim.item.detail.category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    Claim.item.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    Claim.item.detail.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.
    Claim.item.detail.programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    Claim.item.detail.quantity This element must be supported. C 0..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    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.id 0..1 string Unique id for inter-element referencing
    Claim.item.detail.subDetail.extension 0..* Extension Additional content defined by implementations
    Claim.item.detail.subDetail.modifierExtension This element is a modifier element. 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: ExampleRevenueCenterCodes (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: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    Claim.item.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: USCLSCodes (example): Allowable service and product codes.
    Claim.item.detail.subDetail.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.
    Claim.item.detail.subDetail.programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    Claim.item.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
    Constraints: sqty-1
    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

    doco 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 📦2.0.2 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:attending.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:attending.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:operating.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:operating.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:rendering.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:rendering.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:referring.​role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    Claim.careTeam:referring.​qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.2 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 example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.2 This IG
    Claim.supportingInfo:typeOfBill.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:serviceFacility.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    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 example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.2 This IG
    Claim.supportingInfo:drg.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:pointoforigin.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.2 This IG
    Claim.supportingInfo:pointoforigin.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:admtype.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.2 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 v7.1
    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 📦2.0.2 This IG
    Claim.diagnosis:principal.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.diagnosis:admitting.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.diagnosis:patientReasonForVisit.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.diagnosis:externalcauseofinjury.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.diagnosis:other.​type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    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 📦2.0.2 This IG
    Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.2 This IG
    Claim.procedure:other.​type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.2 This IG
    Claim.insurance.coverage.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Claim.accident.type Base extensible ActIncidentCode 📍3.0.0 THO v7.1
    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 📦2.0.2 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 📦2.0.2 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.2 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 📦2.0.2 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 📦2.0.2 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
    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:

    Extensions

    This structure refers to these extensions:

    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