Kenya eClaims FHIR IG
0.1.0 - ci-build Kenya flag

Kenya eClaims FHIR IG, published by iclKenya. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/Kenya-eClaims-FHIR-IG/ and changes regularly. See the Directory of published versions

Resource Profile: Claim Response - Preauthorization

Official URL: https://example.com/fhir/StructureDefinition/eclaims-claim Version: 0.1.0
Draft as of 2025-12-16 Computable Name: EclaimsResponse

This profile defines constraints on the Claim resource for use within the Kenya eClaims Implementation Guide. It supports institutional claims with detailed clinical, financial, insurance, and adjudication metadata.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id SΣ 1..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... profile SΣ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..1 Identifier Business Identifier for claim
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... insurer SΣ 1..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(Organization) Party responsible for the claim
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... related S 0..* BackboneElement Prior or corollary claims
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim S 1..1 Reference(Claim) Reference to the related claim
.... relationship S 1..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
... prescription S 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 1..1 Reference(MedicationRequest) Original prescription if superseded by fulfiller
... payee S 1..1 BackboneElement Recipient of benefits payable
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... party S 0..1 Reference(Patient | Organization) Recipient reference
... referral S 1..1 Reference(ServiceRequest) Treatment referral
... facility S 1..1 Reference(Location) Servicing facility
... careTeam S 1..* BackboneElement Members of the care team
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner) Practitioner or organization
.... role S 1..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... qualification S 1..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
... supportingInfo S 0..* BackboneElement Supporting information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code S 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] S 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] S 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
.... reason S 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
.... type S 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... onAdmission S 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
... insurance SΣ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence SΣ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date S 1..1 date When the incident occurred
.... type S 1..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] S 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 1..* BackboneElement Product or service provided
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 1..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice S 1..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 1..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... detail S 0..* BackboneElement Product or service provided
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Item instance identifier
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice S 1..1 Money Fee, charge or cost per item
..... net S 1..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence S 1..1 positiveInt Item instance identifier
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
....... coding SΣ 1..* Coding Code defined by a terminology system
........ system SΣ 1..1 uri Identity of the terminology system
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept
...... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice S 1..1 Money Fee, charge or cost per item
...... net S 1..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco 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.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example 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 example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
Claim.careTeam.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 example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
Claim.item.productOrService Base example USCLS 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.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id S 1..1 id Logical id of this artifact
... meta S 1..1 Meta Metadata about the resource
.... profile S 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... identifier S 1..1 Identifier Business Identifier for claim
... type S 1..1 CodeableConcept Category or discipline
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... subType S 0..1 CodeableConcept More granular claim type
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... use S 1..1 code claim | preauthorization | predetermination
... patient S 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod S 0..1 Period Relevant time frame for the claim
... created S 1..1 dateTime Resource creation date
... insurer S 1..1 Reference(Organization) Target
... provider S 1..1 Reference(Organization) Party responsible for the claim
... priority S 1..1 CodeableConcept Desired processing ugency
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... related S 0..* BackboneElement Prior or corollary claims
.... claim S 1..1 Reference(Claim) Reference to the related claim
.... relationship S 1..1 CodeableConcept How the reference claim is related
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
... prescription S 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 1..1 Reference(MedicationRequest) Original prescription if superseded by fulfiller
... payee S 1..1 BackboneElement Recipient of benefits payable
.... type S 1..1 CodeableConcept Category of recipient
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... party S 0..1 Reference(Patient | Organization) Recipient reference
... referral S 1..1 Reference(ServiceRequest) Treatment referral
... facility S 1..1 Reference(Location) Servicing facility
... careTeam S 1..* BackboneElement Members of the care team
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner) Practitioner or organization
.... role S 1..1 CodeableConcept Function within the team
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... qualification S 1..1 CodeableConcept Practitioner credential or specialization
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
... supportingInfo S 0..* BackboneElement Supporting information
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
.... code S 0..1 CodeableConcept Type of information
.... timing[x] S 0..1 date, Period When it occurred
.... value[x] S 0..1 boolean, string, Quantity, Attachment, Reference(Resource) Data to be provided
.... reason S 0..1 CodeableConcept Explanation for the information
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
.... type S 1..1 CodeableConcept Timing or nature of the diagnosis
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... onAdmission S 0..1 CodeableConcept Present on admission
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
... insurance S 1..* BackboneElement Patient insurance information
.... sequence S 1..1 positiveInt Insurance instance identifier
.... focal S 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Coverage) Insurance information
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... date S 1..1 date When the incident occurred
.... type S 1..1 CodeableConcept The nature of the accident
.... location[x] S 0..1 Address, Reference(Location) Where the event occurred
... item S 1..* BackboneElement Product or service provided
.... sequence S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 1..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... serviced[x] S 0..1 date, Period Date or dates of service or product delivery
.... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice S 1..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 1..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... detail S 0..* BackboneElement Product or service provided
..... sequence S 1..1 positiveInt Item instance identifier
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice S 1..1 Money Fee, charge or cost per item
..... net S 1..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... sequence S 1..1 positiveInt Item instance identifier
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
....... coding S 1..* Coding Code defined by a terminology system
........ system S 1..1 uri Identity of the terminology system
........ code S 1..1 code Symbol in syntax defined by the system
........ display S 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept
...... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice S 1..1 Money Fee, charge or cost per item
...... net S 1..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id SΣ 1..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile SΣ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..1 Identifier Business Identifier for claim
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer SΣ 1..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(Organization) Party responsible for the claim
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related S 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim S 1..1 Reference(Claim) Reference to the related claim
.... relationship S 1..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... reference 0..1 Identifier File or case reference
... prescription S 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 1..1 Reference(MedicationRequest) Original prescription if superseded by fulfiller
... payee S 1..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... party S 0..1 Reference(Patient | Organization) Recipient reference
... referral S 1..1 Reference(ServiceRequest) Treatment referral
... facility S 1..1 Reference(Location) Servicing facility
... careTeam S 1..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role S 1..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... qualification S 1..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
... supportingInfo S 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code S 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] S 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] S 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
.... reason S 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
.... type S 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... onAdmission S 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance SΣ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence SΣ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date S 1..1 date When the incident occurred
.... type S 1..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] S 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 1..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 1..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice S 1..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 1..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail S 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice S 1..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net S 1..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence S 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... coding SΣ 1..* Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system SΣ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice S 1..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net S 1..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Claim.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
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.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
Claim.careTeam.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 example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
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.procedure.type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
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

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

Summary

Mandatory: 48 elements(37 nested mandatory elements)
Must-Support: 150 elements

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id SΣ 1..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... profile SΣ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..1 Identifier Business Identifier for claim
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... insurer SΣ 1..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(Organization) Party responsible for the claim
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... related S 0..* BackboneElement Prior or corollary claims
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim S 1..1 Reference(Claim) Reference to the related claim
.... relationship S 1..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
... prescription S 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 1..1 Reference(MedicationRequest) Original prescription if superseded by fulfiller
... payee S 1..1 BackboneElement Recipient of benefits payable
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... party S 0..1 Reference(Patient | Organization) Recipient reference
... referral S 1..1 Reference(ServiceRequest) Treatment referral
... facility S 1..1 Reference(Location) Servicing facility
... careTeam S 1..* BackboneElement Members of the care team
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner) Practitioner or organization
.... role S 1..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... qualification S 1..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
... supportingInfo S 0..* BackboneElement Supporting information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code S 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] S 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] S 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
.... reason S 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
.... type S 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... onAdmission S 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
... insurance SΣ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence SΣ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date S 1..1 date When the incident occurred
.... type S 1..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] S 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 1..* BackboneElement Product or service provided
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 1..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice S 1..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 1..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... detail S 0..* BackboneElement Product or service provided
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Item instance identifier
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice S 1..1 Money Fee, charge or cost per item
..... net S 1..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence S 1..1 positiveInt Item instance identifier
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
....... coding SΣ 1..* Coding Code defined by a terminology system
........ system SΣ 1..1 uri Identity of the terminology system
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept
...... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice S 1..1 Money Fee, charge or cost per item
...... net S 1..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco 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.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example 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 example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
Claim.careTeam.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 example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
Claim.item.productOrService Base example USCLS 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.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id S 1..1 id Logical id of this artifact
... meta S 1..1 Meta Metadata about the resource
.... profile S 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... identifier S 1..1 Identifier Business Identifier for claim
... type S 1..1 CodeableConcept Category or discipline
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... subType S 0..1 CodeableConcept More granular claim type
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... use S 1..1 code claim | preauthorization | predetermination
... patient S 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod S 0..1 Period Relevant time frame for the claim
... created S 1..1 dateTime Resource creation date
... insurer S 1..1 Reference(Organization) Target
... provider S 1..1 Reference(Organization) Party responsible for the claim
... priority S 1..1 CodeableConcept Desired processing ugency
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... related S 0..* BackboneElement Prior or corollary claims
.... claim S 1..1 Reference(Claim) Reference to the related claim
.... relationship S 1..1 CodeableConcept How the reference claim is related
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
... prescription S 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 1..1 Reference(MedicationRequest) Original prescription if superseded by fulfiller
... payee S 1..1 BackboneElement Recipient of benefits payable
.... type S 1..1 CodeableConcept Category of recipient
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... party S 0..1 Reference(Patient | Organization) Recipient reference
... referral S 1..1 Reference(ServiceRequest) Treatment referral
... facility S 1..1 Reference(Location) Servicing facility
... careTeam S 1..* BackboneElement Members of the care team
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner) Practitioner or organization
.... role S 1..1 CodeableConcept Function within the team
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... qualification S 1..1 CodeableConcept Practitioner credential or specialization
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
... supportingInfo S 0..* BackboneElement Supporting information
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
.... code S 0..1 CodeableConcept Type of information
.... timing[x] S 0..1 date, Period When it occurred
.... value[x] S 0..1 boolean, string, Quantity, Attachment, Reference(Resource) Data to be provided
.... reason S 0..1 CodeableConcept Explanation for the information
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
.... type S 1..1 CodeableConcept Timing or nature of the diagnosis
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... onAdmission S 0..1 CodeableConcept Present on admission
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
... insurance S 1..* BackboneElement Patient insurance information
.... sequence S 1..1 positiveInt Insurance instance identifier
.... focal S 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Coverage) Insurance information
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... date S 1..1 date When the incident occurred
.... type S 1..1 CodeableConcept The nature of the accident
.... location[x] S 0..1 Address, Reference(Location) Where the event occurred
... item S 1..* BackboneElement Product or service provided
.... sequence S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 1..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... serviced[x] S 0..1 date, Period Date or dates of service or product delivery
.... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice S 1..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 1..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... detail S 0..* BackboneElement Product or service provided
..... sequence S 1..1 positiveInt Item instance identifier
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice S 1..1 Money Fee, charge or cost per item
..... net S 1..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... sequence S 1..1 positiveInt Item instance identifier
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
....... coding S 1..* Coding Code defined by a terminology system
........ system S 1..1 uri Identity of the terminology system
........ code S 1..1 code Symbol in syntax defined by the system
........ display S 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept
...... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice S 1..1 Money Fee, charge or cost per item
...... net S 1..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id SΣ 1..1 id Logical id of this artifact
... meta SΣ 1..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile SΣ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..1 Identifier Business Identifier for claim
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer SΣ 1..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(Organization) Party responsible for the claim
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related S 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim S 1..1 Reference(Claim) Reference to the related claim
.... relationship S 1..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... reference 0..1 Identifier File or case reference
... prescription S 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 1..1 Reference(MedicationRequest) Original prescription if superseded by fulfiller
... payee S 1..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... party S 0..1 Reference(Patient | Organization) Recipient reference
... referral S 1..1 Reference(ServiceRequest) Treatment referral
... facility S 1..1 Reference(Location) Servicing facility
... careTeam S 1..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role S 1..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... qualification S 1..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
... supportingInfo S 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code S 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] S 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] S 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
.... reason S 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
.... type S 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... onAdmission S 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance SΣ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence SΣ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date S 1..1 date When the incident occurred
.... type S 1..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] S 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 1..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 1..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] S 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice S 1..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 1..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail S 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice S 1..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net S 1..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence S 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... coding SΣ 1..* Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system SΣ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity S 1..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice S 1..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net S 1..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.meta.security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
Claim.meta.tag Base example Common Tags 📍4.0.1 FHIR Std.
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.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
Claim.careTeam.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 example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
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.procedure.type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
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

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

Summary

Mandatory: 48 elements(37 nested mandatory elements)
Must-Support: 150 elements

 

Other representations of profile: CSV, Excel, Schematron