NHDR Implementation Guide Release 1.0
0.1.0 - ci-build
NHDR Implementation Guide Release 1.0, published by NHDR. 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/PROJ-PHILHEALTH-EA-NHDR/PhilHealth-NHDR-IG-Review/ and changes regularly. See the Directory of published versions
Official URL: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Claim | Version: 0.1.0 | |||
Standards status: Draft | Computable Name: PH_Claim | |||
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License |
A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.
Usages:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
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0..* | Claim | Claim, Pre-determination or Pre-authorization | |
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |
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0..* | PH_Signature | Signature (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/ExtSignature | |
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?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
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Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
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Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. |
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Σ | 1..1 | Reference(Patient) | The recipient of the products and services |
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Σ | 1..1 | dateTime | Resource creation date |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim |
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Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
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Σ | 1..* | BackboneElement | Patient insurance information |
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Σ | 1..1 | positiveInt | Insurance instance identifier |
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Σ | 1..1 | boolean | Coverage to be used for adjudication |
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Σ | 1..1 | Reference(Coverage) | Insurance information |
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Path | Conformance | ValueSet | URI |
Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard | |
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type From the FHIR Standard | |
Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard | |
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard | |
Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard | |
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory From the FHIR Standard | |
Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard | |
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
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
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
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0..* | Claim | Claim, Pre-determination or Pre-authorization | |
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |
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0..* | PH_Signature | Signature (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/ExtSignature | |
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0..0 | |||
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Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |
![]() ![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact |
![]() ![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource |
![]() ![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() |
0..* | PH_Signature | Signature (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/ExtSignature | |
![]() ![]() ![]() |
0..* | Identifier | Business Identifier for claim | |
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
![]() ![]() ![]() |
Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | The recipient of the products and services |
![]() ![]() ![]() |
Σ | 1..1 | dateTime | Resource creation date |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim |
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
![]() ![]() ![]() |
Σ | 1..* | BackboneElement | Patient insurance information |
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() |
Σ | 1..1 | positiveInt | Insurance instance identifier |
![]() ![]() ![]() ![]() |
Σ | 1..1 | boolean | Coverage to be used for adjudication |
![]() ![]() ![]() ![]() |
0..1 | Identifier | Pre-assigned Claim number | |
![]() ![]() ![]() ![]() |
Σ | 1..1 | Reference(Coverage) | Insurance information |
![]() ![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |
![]() ![]() ![]() ![]() |
0..* | string | Prior authorization reference number | |
![]() ![]() ![]() ![]() |
0..1 | Reference(ClaimResponse) | Adjudication results | |
![]() ![]() ![]() |
0..* | BackboneElement | Product or service provided | |
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Item instance identifier | |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
![]() ![]() ![]() ![]() |
0..1 | Money | Total item cost | |
![]() |
Path | Conformance | ValueSet | URI |
Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard | |
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type From the FHIR Standard | |
Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard | |
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard | |
Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationship From the FHIR Standard | |
Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard | |
Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole From the FHIR Standard | |
Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualification From the FHIR Standard | |
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory From the FHIR Standard | |
Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard | |
Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard | |
Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard | |
Claim.diagnosis.type | example | ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype From the FHIR Standard | |
Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard | |
Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard | |
Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type From the FHIR Standard | |
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard | |
Claim.accident.type | extensible | ActIncidentCodehttp://terminology.hl7.org/ValueSet/v3-ActIncidentCode | |
Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard | |
Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard | |
Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard | |
Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard | |
Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard | |
Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard | |
Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard | |
Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard | |
Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard | |
Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard | |
Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
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
Key Elements View
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |
![]() ![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() |
0..* | PH_Signature | Signature (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/ExtSignature | |
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
![]() ![]() ![]() |
Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | The recipient of the products and services |
![]() ![]() ![]() |
Σ | 1..1 | dateTime | Resource creation date |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim |
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
![]() ![]() ![]() |
Σ | 1..* | BackboneElement | Patient insurance information |
![]() ![]() ![]() ![]() |
Σ | 1..1 | positiveInt | Insurance instance identifier |
![]() ![]() ![]() ![]() |
Σ | 1..1 | boolean | Coverage to be used for adjudication |
![]() ![]() ![]() ![]() |
Σ | 1..1 | Reference(Coverage) | Insurance information |
![]() |
Path | Conformance | ValueSet | URI |
Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard | |
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type From the FHIR Standard | |
Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard | |
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard | |
Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard | |
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory From the FHIR Standard | |
Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard | |
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
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
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
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0..* | Claim | Claim, Pre-determination or Pre-authorization | |
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |
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0..* | PH_Signature | Signature (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/ExtSignature | |
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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Snapshot View
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |
![]() ![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact |
![]() ![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource |
![]() ![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() |
0..* | PH_Signature | Signature (Extension) URL: https://nhdr.gov.ph/fhir/StructureDefinition/ExtSignature | |
![]() ![]() ![]() |
0..* | Identifier | Business Identifier for claim | |
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
![]() ![]() ![]() |
Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | The recipient of the products and services |
![]() ![]() ![]() |
Σ | 1..1 | dateTime | Resource creation date |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim |
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
![]() ![]() ![]() |
Σ | 1..* | BackboneElement | Patient insurance information |
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() |
Σ | 1..1 | positiveInt | Insurance instance identifier |
![]() ![]() ![]() ![]() |
Σ | 1..1 | boolean | Coverage to be used for adjudication |
![]() ![]() ![]() ![]() |
0..1 | Identifier | Pre-assigned Claim number | |
![]() ![]() ![]() ![]() |
Σ | 1..1 | Reference(Coverage) | Insurance information |
![]() ![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |
![]() ![]() ![]() ![]() |
0..* | string | Prior authorization reference number | |
![]() ![]() ![]() ![]() |
0..1 | Reference(ClaimResponse) | Adjudication results | |
![]() ![]() ![]() |
0..* | BackboneElement | Product or service provided | |
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Item instance identifier | |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
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0..1 | Money | Total item cost | |
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Path | Conformance | ValueSet | URI |
Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard | |
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type From the FHIR Standard | |
Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard | |
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard | |
Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationship From the FHIR Standard | |
Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard | |
Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole From the FHIR Standard | |
Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualification From the FHIR Standard | |
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory From the FHIR Standard | |
Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard | |
Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard | |
Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard | |
Claim.diagnosis.type | example | ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype From the FHIR Standard | |
Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard | |
Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard | |
Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type From the FHIR Standard | |
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard | |
Claim.accident.type | extensible | ActIncidentCodehttp://terminology.hl7.org/ValueSet/v3-ActIncidentCode | |
Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard | |
Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard | |
Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard | |
Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard | |
Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard | |
Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard | |
Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard | |
Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard | |
Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard | |
Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard | |
Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
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
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