PCT Good Faith Estimate Summary - Patient Cost Transparency Implementation Guide v2.0.2

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

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-summary	Version: 2.0.2	Highlight text changes?
Standards status: Trial-use	Maturity Level: 1	Computable Name: PCTGFESummary
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.17

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

Usages:

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

You can also check for usages in the FHIR IG Statistics

Changes since version 1.1.0:

New Content

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

Key Elements Table
Differential Table
Snapshot Table
Statistics/References
All

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
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:gfeDisclaimer	This element must be supported.	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
Claim.Slices for extension.extension:serviceDescription	This element must be supported.	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
Claim.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse", "code" : "estimate-summary" } ] }`
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	The full Period of Care for all services or products included in the estimate from the first event to the last event.
Claim.created	This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.insurer	This element must be supported. This element is included in summaries.	0..1	Reference(PCT Organization)	Target
Claim.provider	This element is included in summaries.	1..1	Reference(Practitioner \| PractitionerRole \| Organization)	Party responsible for the claim
Claim.provider.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
Claim.provider.Slices for extension.extension:dataAbsentReason		1..1	(Complex)	unknown \| asked \| temp \| notasked \| masked \| unsupported \| astext \| error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Claim.provider.Slices for extension.extension:dataAbsentReason.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.provider.Slices for extension.extension:dataAbsentReason.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
Claim.provider.Slices for extension.extension:dataAbsentReason.value[x]		1..1	code	Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable (extensions allowed)
Claim.priority	This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
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 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:anesthesiaRelated	This element must be supported.	0..2	BackboneElement	Clinical procedures performed
Claim.Slices for procedure.procedure:anesthesiaRelated.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
Claim.Slices for procedure.procedure:anesthesiaRelated.Slices for extension				Content/Rules for all slices
Claim.Slices for procedure.procedure:anesthesiaRelated.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:anesthesiaRelated.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:anesthesiaRelated.sequence		1..1	positiveInt	Procedure instance identifier
Claim.Slices for procedure.procedure:anesthesiaRelated.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" : "procedureRequiringAnesthesia" } ] }`
Claim.Slices for procedure.procedure:anesthesiaRelated.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	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.total		1..1	Money	Total GFE Charges
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
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.provider.extension:dataAbsentReason.value[x]	Base	required	DataAbsentReason	📦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	example	Claim Information Category 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: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:anesthesiaRelated.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure:anesthesiaRelated.procedure[x]	Base	required	PCT CMS HCPCS and AMA CPT Procedure Surgical 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.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Grade

Path(s)

Description

Expression

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim			Claim
Claim.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Claim.Slices for extension.extension:gfeDisclaimer	This element must be supported.	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
Claim.Slices for extension.extension:serviceDescription	This element must be supported.	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
Claim.type		1..1	CodeableConcept	Category or discipline Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse", "code" : "estimate-summary" } ] }`
Claim.subType		0..0		More granular claim type
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	The full Period of Care for all services or products included in the estimate from the first event to the last event.
Claim.enterer		0..0		Author of the claim
Claim.insurer	This element must be supported.	0..1	Reference(PCT Organization)	Target
Claim.provider
Claim.provider.extension		1..*	Extension	Extension
Claim.provider.Slices for extension				Content/Rules for all slices
Claim.provider.Slices for extension.extension:dataAbsentReason		1..1	(Complex)	unknown \| asked \| temp \| notasked \| masked \| unsupported \| astext \| error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Claim.provider.Slices for extension.extension:dataAbsentReason.value[x]		1..1	code	Value of extension Required Pattern: not-applicable (extensions allowed)
Claim.provider.reference		0..0		Literal reference, Relative, internal or absolute URL
Claim.provider.type		0..0		Type the reference refers to (e.g. "Patient")
Claim.provider.identifier		0..0		Logical reference, when literal reference is not known
Claim.provider.display		0..0		Text alternative for the resource
Claim.priority		1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Claim.fundsReserve		0..0		For whom to reserve funds
Claim.prescription		0..0		Prescription authorizing services and products
Claim.originalPrescription		0..0		Original prescription if superseded by fulfiller
Claim.payee		0..0		Recipient of benefits payable
Claim.referral		0..0		Treatment referral
Claim.facility		0..0		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.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.supportingInfo		0..0		Supporting information
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:anesthesiaRelated	This element must be supported.	0..2	BackboneElement	Clinical procedures performed
Claim.Slices for procedure.procedure:anesthesiaRelated.Slices for extension				Content/Rules for all slices
Claim.Slices for procedure.procedure:anesthesiaRelated.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:anesthesiaRelated.type		1..1	CodeableConcept	Category of Procedure Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType", "code" : "procedureRequiringAnesthesia" } ] }`
Claim.Slices for procedure.procedure:anesthesiaRelated.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	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.preAuthRef		0..0		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		0..0		Product or service provided
Claim.total		1..1	Money	Total GFE Charges
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.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:anesthesiaRelated.procedure[x]	Base	required	PCT CMS HCPCS and AMA CPT Procedure Surgical 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.

Description & Constraints Filter:

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

language

0..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

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:gfeDisclaimer This element must be supported. 0..* string Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer

Claim.Slices for extension.extension:serviceDescription This element must be supported. 0..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription

Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored

Claim.identifier 0..* Identifier Business Identifier for claim

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.

type

1..1

CodeableConcept

Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern:

{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse",
      "code" : "estimate-summary"
    }
  ]
}

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 The full Period of Care for all services or products included in the estimate from the first event to the last event.

Claim.created This element is included in summaries. 1..1 dateTime Resource creation date

Claim.insurer This element must be supported. This element is included in summaries. 0..1 Reference(PCT Organization) Target

Claim.provider This element is included in summaries. 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim

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:dataAbsentReason.id 0..1 string Unique id for inter-element referencing

Claim.provider.Slices for extension.extension:dataAbsentReason.extension 0..0 Extension
Slice: Unordered, Open by value:url

Claim.provider.Slices for extension.extension:dataAbsentReason.url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"

Claim.provider.Slices for extension.extension:dataAbsentReason.value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Required Pattern: not-applicable (extensions allowed)

Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)

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.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

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

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

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

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 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)

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)

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)

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)

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)

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)

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:anesthesiaRelated This element must be supported. 0..2 BackboneElement Clinical procedures performed

Claim.Slices for procedure.procedure:anesthesiaRelated.id 0..1 string Unique id for inter-element referencing

Claim.Slices for procedure.procedure:anesthesiaRelated.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url

Claim.Slices for procedure.procedure:anesthesiaRelated.Slices for extension Content/Rules for all slices

Claim.Slices for procedure.procedure:anesthesiaRelated.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:anesthesiaRelated.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:anesthesiaRelated.sequence 1..1 positiveInt Procedure instance identifier

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" : "procedureRequiringAnesthesia"
    }
  ]
}

Claim.Slices for procedure.procedure:anesthesiaRelated.date 0..1 dateTime When the procedure was performed

Claim.Slices for procedure.procedure:anesthesiaRelated.procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)

Claim.Slices for procedure.procedure:anesthesiaRelated.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

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.businessArrangement 0..1 string Additional provider contract 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.total 1..1 Money Total GFE Charges

Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.language	Base	preferred	Common Languages	📍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.provider.extension:dataAbsentReason.value[x]	Base	required	DataAbsentReason	📦4.0.1	FHIR Std.
Claim.priority	Base	required	Process Priority Codes	📦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.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	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
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.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:anesthesiaRelated.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure:anesthesiaRelated.procedure[x]	Base	required	PCT CMS HCPCS and AMA CPT Procedure Surgical 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.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	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
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.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	example	USCLS Codes	📍4.0.1	FHIR Std.
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

Grade

Path(s)

Description

Expression

This structure is derived from Claim

Summary

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

Structures

This structure refers to these other structures:

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

Maturity: 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
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:gfeDisclaimer	This element must be supported.	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
Claim.Slices for extension.extension:serviceDescription	This element must be supported.	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
Claim.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
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://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse", "code" : "estimate-summary" } ] }`
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	The full Period of Care for all services or products included in the estimate from the first event to the last event.
Claim.created	This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.insurer	This element must be supported. This element is included in summaries.	0..1	Reference(PCT Organization)	Target
Claim.provider	This element is included in summaries.	1..1	Reference(Practitioner \| PractitionerRole \| Organization)	Party responsible for the claim
Claim.provider.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
Claim.provider.Slices for extension.extension:dataAbsentReason		1..1	(Complex)	unknown \| asked \| temp \| notasked \| masked \| unsupported \| astext \| error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Claim.provider.Slices for extension.extension:dataAbsentReason.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.provider.Slices for extension.extension:dataAbsentReason.url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/data-absent-reason"
Claim.provider.Slices for extension.extension:dataAbsentReason.value[x]		1..1	code	Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable (extensions allowed)
Claim.priority	This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
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 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:anesthesiaRelated	This element must be supported.	0..2	BackboneElement	Clinical procedures performed
Claim.Slices for procedure.procedure:anesthesiaRelated.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
Claim.Slices for procedure.procedure:anesthesiaRelated.Slices for extension				Content/Rules for all slices
Claim.Slices for procedure.procedure:anesthesiaRelated.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:anesthesiaRelated.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:anesthesiaRelated.sequence		1..1	positiveInt	Procedure instance identifier
Claim.Slices for procedure.procedure:anesthesiaRelated.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" : "procedureRequiringAnesthesia" } ] }`
Claim.Slices for procedure.procedure:anesthesiaRelated.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	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.total		1..1	Money	Total GFE Charges
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
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.provider.extension:dataAbsentReason.value[x]	Base	required	DataAbsentReason	📦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	example	Claim Information Category 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: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:anesthesiaRelated.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure:anesthesiaRelated.procedure[x]	Base	required	PCT CMS HCPCS and AMA CPT Procedure Surgical 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.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Grade

Path(s)

Description

Expression

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim			Claim
Claim.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
Claim.Slices for extension.extension:gfeDisclaimer	This element must be supported.	0..*	string	Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
Claim.Slices for extension.extension:serviceDescription	This element must be supported.	0..1	string	Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
Claim.type		1..1	CodeableConcept	Category or discipline Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse", "code" : "estimate-summary" } ] }`
Claim.subType		0..0		More granular claim type
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	The full Period of Care for all services or products included in the estimate from the first event to the last event.
Claim.enterer		0..0		Author of the claim
Claim.insurer	This element must be supported.	0..1	Reference(PCT Organization)	Target
Claim.provider
Claim.provider.extension		1..*	Extension	Extension
Claim.provider.Slices for extension				Content/Rules for all slices
Claim.provider.Slices for extension.extension:dataAbsentReason		1..1	(Complex)	unknown \| asked \| temp \| notasked \| masked \| unsupported \| astext \| error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Claim.provider.Slices for extension.extension:dataAbsentReason.value[x]		1..1	code	Value of extension Required Pattern: not-applicable (extensions allowed)
Claim.provider.reference		0..0		Literal reference, Relative, internal or absolute URL
Claim.provider.type		0..0		Type the reference refers to (e.g. "Patient")
Claim.provider.identifier		0..0		Logical reference, when literal reference is not known
Claim.provider.display		0..0		Text alternative for the resource
Claim.priority		1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Claim.fundsReserve		0..0		For whom to reserve funds
Claim.prescription		0..0		Prescription authorizing services and products
Claim.originalPrescription		0..0		Original prescription if superseded by fulfiller
Claim.payee		0..0		Recipient of benefits payable
Claim.referral		0..0		Treatment referral
Claim.facility		0..0		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.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.supportingInfo		0..0		Supporting information
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:anesthesiaRelated	This element must be supported.	0..2	BackboneElement	Clinical procedures performed
Claim.Slices for procedure.procedure:anesthesiaRelated.Slices for extension				Content/Rules for all slices
Claim.Slices for procedure.procedure:anesthesiaRelated.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:anesthesiaRelated.type		1..1	CodeableConcept	Category of Procedure Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType", "code" : "procedureRequiringAnesthesia" } ] }`
Claim.Slices for procedure.procedure:anesthesiaRelated.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	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.preAuthRef		0..0		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		0..0		Product or service provided
Claim.total		1..1	Money	Total GFE Charges
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.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:anesthesiaRelated.procedure[x]	Base	required	PCT CMS HCPCS and AMA CPT Procedure Surgical 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.

Snapshot ViewView

Description & Constraints Filter:

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

language

0..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

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:serviceDescription This element must be supported. 0..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription

Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored

Claim.identifier 0..* Identifier Business Identifier for claim

type

1..1

CodeableConcept

Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern:

{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse",
      "code" : "estimate-summary"
    }
  ]
}