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.

The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

An Extension

Extension to capture healthcare encounters.

An Extension

The status of the resource instance.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

A code specifying the state of the resource instance.

Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.

The type or discipline-style of the claim.

Claim type determine the general sets of business rules applied for information requirements and adjudication.

A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

A more granular claim typecode.

Some jurisdictions need a finer grained claim type for routing and adjudication.

A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

The purpose of the Claim: predetermination, preauthorization, claim.

This element is required to understand the nature of the request for adjudication.

The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

The period for which charges are being submitted.

Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.

A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

The date when the claim document was created in the facility.

This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

Need to record a timestamp for use by both the recipient and the issuer.

Individual who created the claim, predetermination or preauthorization.

Some jurisdictions require the contact information for personnel completing claims.

The Insurer who is target of the request.

The provider which is responsible for the claim, predetermination or preauthorization.

Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.

The timeliness with which processing is required: stat, normal, deferred.

The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

A code to indicate whether and for whom funds are to be reserved for future claims.

This field is only used for preauthorizations.

For whom funds are to be reserved: (Patient, Provider, None).

In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

For example, for the original treatment and follow-up exams.

For workplace or other accidents it is common to relate separate claims arising from the same event.

Prescription to support the dispensing of pharmacy, device or vision products.

Required to authorize the dispensing of controlled substances and devices.

Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.

A reference to a referral resource.

The referral resource which lists the date, practitioner, reason and other supporting information.

Some insurers require proof of referral to pay for services or to pay specialist rates for services.

Facility where the services were provided.

Insurance adjudication can be dependant on where services were delivered.

Financial instruments for reimbursement for the health care products and services specified on the claim.

All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

At least one insurer is required for a claim to be a claim.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

An Extension

A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.

To maintain order of the coverages.

A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.

To identify which coverage in the list is being used to adjudicate this claim.

The business identifier to be used when the claim is sent for adjudication against this insurance policy.

Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'.

This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication.

Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

Required to allow the adjudicator to locate the correct policy and history within their information system.

A business agreement number established between the provider and the insurer for special business processing purposes.

Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.

Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.

This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.

Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

The result of the adjudication of the line items for the Coverage specified in this insurance.

Must not be specified when 'focal=true' for this insurance.

An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.

Details of an accident which resulted in injuries which required the products and services listed in the claim.

When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.

A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

The items to be processed for adjudication.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

An Extension

A number to uniquely identify item entries.

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

CareTeam members related to this service or product.

Need to identify the individuals and their roles in the provision of the product or service.

Diagnosis applicable for this service or product.

Need to related the product or service to the associated diagnoses.

Procedures applicable for this service or product.

Need to provide any listed specific procedures to support the product or service being claimed.

Exceptions, special conditions and supporting information applicable for this service or product.

Need to reference the supporting information items that relate directly to this product or service.

The type of revenue or cost center providing the product and/or service.

Codes for the revenue or cost centers supplying the service and/or products.

Needed in the processing of institutional claims.

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Allowable service and product codes.

Necessary to state what was provided or done.

Item typification or modifiers codes to convey additional context for the product or service.

For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

To support inclusion of the item for adjudication or to charge an elevated fee.

Identifies the program under which this may be recovered.

For example: Neonatal program, child dental program or drug users recovery program.

Program specific reason codes.

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Where the product or service was provided.

Place of service: pharmacy, school, prison, etc.

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

The amount charged to the patient by the provider for a single unit.

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Unique Device Identifiers associated with this line item.

The UDI code allows the insurer to obtain device level information on the product supplied.

Physical service site on the patient (limb, tooth, etc.).

For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

The code for the teeth, quadrant, sextant and arch.

Allows insurer to validate specific procedures.

A region or surface of the bodySite, e.g. limb region or tooth surface(s).

The code for the tooth surface and surface combinations.

Allows insurer to validate specific procedures.

The Encounters during which this Claim was created or to which the creation of this record is tightly associated.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

Used in some jurisdictions to link clinical events to claim items.

A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

The items to be processed for adjudication.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

An Extension

A number to uniquely identify item entries.

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

CareTeam members related to this service or product.

Need to identify the individuals and their roles in the provision of the product or service.

Diagnosis applicable for this service or product.

Need to related the product or service to the associated diagnoses.

Procedures applicable for this service or product.

Need to provide any listed specific procedures to support the product or service being claimed.

Exceptions, special conditions and supporting information applicable for this service or product.

Need to reference the supporting information items that relate directly to this product or service.

The type of revenue or cost center providing the product and/or service.

Codes for the revenue or cost centers supplying the service and/or products.

Needed in the processing of institutional claims.

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Allowable service and product codes.

Necessary to state what was provided or done.

Item typification or modifiers codes to convey additional context for the product or service.

For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

To support inclusion of the item for adjudication or to charge an elevated fee.

Identifies the program under which this may be recovered.

For example: Neonatal program, child dental program or drug users recovery program.

Program specific reason codes.

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Where the product or service was provided.

Place of service: pharmacy, school, prison, etc.

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

The amount charged to the patient by the provider for a single unit.

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Unique Device Identifiers associated with this line item.

The UDI code allows the insurer to obtain device level information on the product supplied.

Physical service site on the patient (limb, tooth, etc.).

For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

The code for the teeth, quadrant, sextant and arch.

Allows insurer to validate specific procedures.

A region or surface of the bodySite, e.g. limb region or tooth surface(s).

The code for the tooth surface and surface combinations.

Allows insurer to validate specific procedures.

The Encounters during which this Claim was created or to which the creation of this record is tightly associated.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

Used in some jurisdictions to link clinical events to claim items.

A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

The items to be processed for adjudication.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

An Extension

A number to uniquely identify item entries.

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

CareTeam members related to this service or product.

Need to identify the individuals and their roles in the provision of the product or service.

Diagnosis applicable for this service or product.

Need to related the product or service to the associated diagnoses.

Procedures applicable for this service or product.

Need to provide any listed specific procedures to support the product or service being claimed.

Exceptions, special conditions and supporting information applicable for this service or product.

Need to reference the supporting information items that relate directly to this product or service.

The type of revenue or cost center providing the product and/or service.

Codes for the revenue or cost centers supplying the service and/or products.

Needed in the processing of institutional claims.

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Allowable service and product codes.

Necessary to state what was provided or done.

Item typification or modifiers codes to convey additional context for the product or service.

For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

To support inclusion of the item for adjudication or to charge an elevated fee.

Identifies the program under which this may be recovered.

For example: Neonatal program, child dental program or drug users recovery program.

Program specific reason codes.

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Where the product or service was provided.

Place of service: pharmacy, school, prison, etc.

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

The amount charged to the patient by the provider for a single unit.

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Unique Device Identifiers associated with this line item.

The UDI code allows the insurer to obtain device level information on the product supplied.

Physical service site on the patient (limb, tooth, etc.).

For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

The code for the teeth, quadrant, sextant and arch.

Allows insurer to validate specific procedures.

A region or surface of the bodySite, e.g. limb region or tooth surface(s).

The code for the tooth surface and surface combinations.

Allows insurer to validate specific procedures.

The Encounters during which this Claim was created or to which the creation of this record is tightly associated.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

Used in some jurisdictions to link clinical events to claim items.

A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

The items to be processed for adjudication.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

An Extension

A number to uniquely identify item entries.

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

CareTeam members related to this service or product.

Need to identify the individuals and their roles in the provision of the product or service.

Diagnosis applicable for this service or product.

Need to related the product or service to the associated diagnoses.

Procedures applicable for this service or product.

Need to provide any listed specific procedures to support the product or service being claimed.

Exceptions, special conditions and supporting information applicable for this service or product.

Need to reference the supporting information items that relate directly to this product or service.

The type of revenue or cost center providing the product and/or service.

Codes for the revenue or cost centers supplying the service and/or products.

Needed in the processing of institutional claims.

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Allowable service and product codes.

Necessary to state what was provided or done.

Item typification or modifiers codes to convey additional context for the product or service.

For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

To support inclusion of the item for adjudication or to charge an elevated fee.

Identifies the program under which this may be recovered.

For example: Neonatal program, child dental program or drug users recovery program.

Program specific reason codes.

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Where the product or service was provided.

Place of service: pharmacy, school, prison, etc.

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

The amount charged to the patient by the provider for a single unit.

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Unique Device Identifiers associated with this line item.

The UDI code allows the insurer to obtain device level information on the product supplied.

Physical service site on the patient (limb, tooth, etc.).

For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

The code for the teeth, quadrant, sextant and arch.

Allows insurer to validate specific procedures.

A region or surface of the bodySite, e.g. limb region or tooth surface(s).

The code for the tooth surface and surface combinations.

Allows insurer to validate specific procedures.

The Encounters during which this Claim was created or to which the creation of this record is tightly associated.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

Used in some jurisdictions to link clinical events to claim items.

A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

The items to be processed for adjudication.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

An Extension

A number to uniquely identify item entries.

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

CareTeam members related to this service or product.

Need to identify the individuals and their roles in the provision of the product or service.

Diagnosis applicable for this service or product.

Need to related the product or service to the associated diagnoses.

Procedures applicable for this service or product.

Need to provide any listed specific procedures to support the product or service being claimed.

Exceptions, special conditions and supporting information applicable for this service or product.

Need to reference the supporting information items that relate directly to this product or service.

The type of revenue or cost center providing the product and/or service.

Codes for the revenue or cost centers supplying the service and/or products.

Needed in the processing of institutional claims.

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Allowable service and product codes.

Necessary to state what was provided or done.

Item typification or modifiers codes to convey additional context for the product or service.

For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

To support inclusion of the item for adjudication or to charge an elevated fee.

Identifies the program under which this may be recovered.

For example: Neonatal program, child dental program or drug users recovery program.

Program specific reason codes.

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Where the product or service was provided.

Place of service: pharmacy, school, prison, etc.

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

The amount charged to the patient by the provider for a single unit.

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Unique Device Identifiers associated with this line item.

The UDI code allows the insurer to obtain device level information on the product supplied.

Physical service site on the patient (limb, tooth, etc.).

For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

The code for the teeth, quadrant, sextant and arch.

Allows insurer to validate specific procedures.

A region or surface of the bodySite, e.g. limb region or tooth surface(s).

The code for the tooth surface and surface combinations.

Allows insurer to validate specific procedures.

The Encounters during which this Claim was created or to which the creation of this record is tightly associated.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

Used in some jurisdictions to link clinical events to claim items.

A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

The items to be processed for adjudication.