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/UP-Manila-SILab/PhilHealth-NHDR-IG-Review/ and changes regularly. See the Directory of published versions

Resource Profile: PH Claim - dummy

Official URL: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Claim-dummy Version: 0.1.0
Standards status: Draft Computable Name: PH_Claim_dummy

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

This is just a sample template for slicing on Claim.item.

Usages:

  • This Profile is not used by any profiles in this Specification

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: doco
Claim 0..* Claim Information about an individual receiving health care services
Claim.id This element is included in summaries. 0..1 id test
Claim.meta This element is included in summaries. 0..1 Meta test
Claim.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri test
Claim.language 0..1 code test
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Claim.text 0..1 Narrative test
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.contained 0..* Resource test
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type This element is included in summaries. 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.use This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient This element is included in summaries. 1..1 Reference(Patient) The recipient of the products and services
Claim.created This element is included in summaries. 1..1 dateTime Resource creation date
Claim.provider This element is included in summaries. 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.insurance This element is included in summaries. 1..* BackboneElement Patient insurance information
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(Coverage) Insurance information
Claim.Slices for item 0..* BackboneElement Product or service provided
Slice: Unordered, Closed by value:productOrService

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for item.item:All Slices Content/Rules for all slices
Claim.Slices for item.item:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:All Slices.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:All Slices.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:AnimalBites 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:AnimalBites.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:AnimalBites.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Marital Status Codes (required)
Claim.Slices for item.item:TBDOTS 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:TBDOTS.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:TBDOTS.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: PatientRelationshipType (required)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​productOrService Base required MaritalStatus 📦4.0.1 FHIR Std.
Claim.item:TBDOTS.productOrService Base required Patient relationship type 📦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: doco
Claim 0..* Claim Information about an individual receiving health care services
Claim.id 0..1 id test
Claim.meta 0..1 Meta test
Claim.implicitRules 0..1 uri test
Claim.text 0..1 Narrative test
Claim.contained 0..* Resource test
Claim.Slices for item 0..* BackboneElement Product or service provided
Slice: Unordered, Closed by value:productOrService
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for item.item:AnimalBites 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Marital Status Codes (required)
Claim.Slices for item.item:TBDOTS 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: PatientRelationshipType (required)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.item:AnimalBites.​productOrService Base required MaritalStatus 📦4.0.1 FHIR Std.
Claim.item:TBDOTS.productOrService Base required Patient relationship type 📦4.0.1 FHIR Std.
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim 0..* Claim Information about an individual receiving health care services
Claim.id This element is included in summaries. 0..1 id test
Claim.meta This element is included in summaries. 0..1 Meta test
Claim.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri test
Claim.language 0..1 code test
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Claim.text 0..1 Narrative test
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.contained 0..* Resource test
Claim.extension 0..* Extension Additional content defined by implementations
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier 0..* Identifier Business Identifier for claim
Claim.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type This element is included in summaries. 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.use This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient This element is included in summaries. 1..1 Reference(Patient) The recipient of the products and services
Claim.billablePeriod This element is included in summaries. 0..1 Period Relevant time frame for the claim
Claim.created This element is included in summaries. 1..1 dateTime Resource creation date
Claim.enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
Claim.insurer This element is included in summaries. 0..1 Reference(Organization) Target
Claim.provider This element is included in summaries. 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related 0..* BackboneElement Prior or corollary claims
Claim.related.id 0..1 string Unique id for inter-element referencing
Claim.related.extension 0..* Extension Additional content defined by implementations
Claim.related.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.related.claim 0..1 Reference(Claim) Reference to the related claim
Claim.related.relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference 0..1 Identifier File or case reference
Claim.prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
Claim.originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
Claim.payee 0..1 BackboneElement Recipient of benefits payable
Claim.payee.id 0..1 string Unique id for inter-element referencing
Claim.payee.extension 0..* Extension Additional content defined by implementations
Claim.payee.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.payee.type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.payee.party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
Claim.referral 0..1 Reference(ServiceRequest) Treatment referral
Claim.facility 0..1 Reference(Location) Servicing facility
Claim.careTeam 0..* BackboneElement Members of the care team
Claim.careTeam.id 0..1 string Unique id for inter-element referencing
Claim.careTeam.extension 0..* Extension Additional content defined by implementations
Claim.careTeam.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.careTeam.sequence 1..1 positiveInt Order of care team
Claim.careTeam.provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
Claim.careTeam.responsible 0..1 boolean Indicator of the lead practitioner
Claim.careTeam.role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.careTeam.qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.supportingInfo 0..* BackboneElement Supporting information
Claim.supportingInfo.id 0..1 string Unique id for inter-element referencing
Claim.supportingInfo.extension 0..* Extension Additional content defined by implementations
Claim.supportingInfo.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence 1..1 positiveInt Information instance identifier
Claim.supportingInfo.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.supportingInfo.timing[x] 0..1 When it occurred
Claim.supportingInfo.timing[x].timingDate date
Claim.supportingInfo.timing[x].timingPeriod Period
Claim.supportingInfo.value[x] 0..1 Data to be provided
Claim.supportingInfo.value[x].valueBoolean boolean
Claim.supportingInfo.value[x].valueString string
Claim.supportingInfo.value[x].valueQuantity Quantity
Claim.supportingInfo.value[x].valueAttachment Attachment
Claim.supportingInfo.value[x].valueReference Reference(Resource)
Claim.supportingInfo.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis 0..* BackboneElement Pertinent diagnosis information
Claim.diagnosis.id 0..1 string Unique id for inter-element referencing
Claim.diagnosis.extension 0..* Extension Additional content defined by implementations
Claim.diagnosis.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence 1..1 positiveInt Diagnosis instance identifier
Claim.diagnosis.diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference Reference(Condition)
Claim.diagnosis.type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
Claim.diagnosis.packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Claim.procedure 0..* BackboneElement Clinical procedures performed
Claim.procedure.id 0..1 string Unique id for inter-element referencing
Claim.procedure.extension 0..* Extension Additional content defined by implementations
Claim.procedure.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence 1..1 positiveInt Procedure instance identifier
Claim.procedure.type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
Claim.procedure.date 0..1 dateTime When the procedure was performed
Claim.procedure.procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept CodeableConcept
Claim.procedure.procedure[x].procedureReference Reference(Procedure)
Claim.procedure.udi 0..* Reference(Device) Unique device identifier
Claim.insurance This element is included in summaries. 1..* BackboneElement Patient insurance information
Claim.insurance.id 0..1 string Unique id for inter-element referencing
Claim.insurance.extension 0..* Extension Additional content defined by implementations
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
Claim.insurance.identifier 0..1 Identifier Pre-assigned Claim number
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(Coverage) Insurance information
Claim.insurance.businessArrangement 0..1 string Additional provider contract number
Claim.insurance.preAuthRef 0..* string Prior authorization reference number
Claim.insurance.claimResponse 0..1 Reference(ClaimResponse) Adjudication results
Claim.accident 0..1 BackboneElement Details of the event
Claim.accident.id 0..1 string Unique id for inter-element referencing
Claim.accident.extension 0..* Extension Additional content defined by implementations
Claim.accident.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.accident.date 1..1 date When the incident occurred
Claim.accident.type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x] 0..1 Where the event occurred
Claim.accident.location[x].locationAddress Address
Claim.accident.location[x].locationReference Reference(Location)
Claim.Slices for item 0..* BackboneElement Product or service provided
Slice: Unordered, Closed by value:productOrService

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for item.item:All Slices Content/Rules for all slices
Claim.Slices for item.item:All Slices.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:All Slices.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:All Slices.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:All Slices.careTeamSequence 0..* positiveInt Applicable careTeam members
Claim.Slices for item.item:All Slices.diagnosisSequence 0..* positiveInt Applicable diagnoses
Claim.Slices for item.item:All Slices.procedureSequence 0..* positiveInt Applicable procedures
Claim.Slices for item.item:All Slices.informationSequence 0..* positiveInt Applicable exception and supporting information
Claim.Slices for item.item:All Slices.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:All Slices.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:All Slices.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:All Slices.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.
Claim.Slices for item.item:All Slices.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:All Slices.serviced[x] 0..1 Date or dates of service or product delivery
Claim.Slices for item.item:All Slices.serviced[x].servicedDate date
Claim.Slices for item.item:All Slices.serviced[x].servicedPeriod Period
Claim.Slices for item.item:All Slices.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.Slices for item.item:All Slices.location[x].locationCodeableConcept CodeableConcept
Claim.Slices for item.item:All Slices.location[x].locationAddress Address
Claim.Slices for item.item:All Slices.location[x].locationReference Reference(Location)
Claim.Slices for item.item:All Slices.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:All Slices.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:All Slices.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:All Slices.net 0..1 Money Total item cost
Claim.Slices for item.item:All Slices.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:All Slices.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.Slices for item.item:All Slices.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.Slices for item.item:All Slices.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.Slices for item.item:All Slices.detail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:All Slices.detail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:All Slices.detail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:All Slices.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:All Slices.detail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:All Slices.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:All Slices.detail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:All Slices.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:All Slices.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:All Slices.detail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:All Slices.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:All Slices.detail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:All Slices.detail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:All Slices.detail.net 0..1 Money Total item cost
Claim.Slices for item.item:All Slices.detail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:All Slices.detail.subDetail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:All Slices.detail.subDetail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:All Slices.detail.subDetail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:All Slices.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:All Slices.detail.subDetail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:All Slices.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:All Slices.detail.subDetail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:All Slices.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:All Slices.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:All Slices.detail.subDetail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:All Slices.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:All Slices.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:All Slices.detail.subDetail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:All Slices.detail.subDetail.net 0..1 Money Total item cost
Claim.Slices for item.item:All Slices.detail.subDetail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:AnimalBites 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:AnimalBites.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:AnimalBites.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:AnimalBites.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:AnimalBites.careTeamSequence 0..* positiveInt Applicable careTeam members
Claim.Slices for item.item:AnimalBites.diagnosisSequence 0..* positiveInt Applicable diagnoses
Claim.Slices for item.item:AnimalBites.procedureSequence 0..* positiveInt Applicable procedures
Claim.Slices for item.item:AnimalBites.informationSequence 0..* positiveInt Applicable exception and supporting information
Claim.Slices for item.item:AnimalBites.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:AnimalBites.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:AnimalBites.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Marital Status Codes (required)
Claim.Slices for item.item:AnimalBites.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.
Claim.Slices for item.item:AnimalBites.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:AnimalBites.serviced[x] 0..1 Date or dates of service or product delivery
Claim.Slices for item.item:AnimalBites.serviced[x].servicedDate date
Claim.Slices for item.item:AnimalBites.serviced[x].servicedPeriod Period
Claim.Slices for item.item:AnimalBites.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.Slices for item.item:AnimalBites.location[x].locationCodeableConcept CodeableConcept
Claim.Slices for item.item:AnimalBites.location[x].locationAddress Address
Claim.Slices for item.item:AnimalBites.location[x].locationReference Reference(Location)
Claim.Slices for item.item:AnimalBites.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:AnimalBites.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:AnimalBites.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:AnimalBites.net 0..1 Money Total item cost
Claim.Slices for item.item:AnimalBites.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:AnimalBites.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.Slices for item.item:AnimalBites.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.Slices for item.item:AnimalBites.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.Slices for item.item:AnimalBites.detail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.detail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:AnimalBites.detail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:AnimalBites.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:AnimalBites.detail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:AnimalBites.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:AnimalBites.detail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:AnimalBites.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:AnimalBites.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:AnimalBites.detail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:AnimalBites.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:AnimalBites.detail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:AnimalBites.detail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:AnimalBites.detail.net 0..1 Money Total item cost
Claim.Slices for item.item:AnimalBites.detail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:AnimalBites.detail.subDetail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.detail.subDetail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:AnimalBites.detail.subDetail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:AnimalBites.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:AnimalBites.detail.subDetail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:AnimalBites.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:AnimalBites.detail.subDetail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:AnimalBites.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:AnimalBites.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:AnimalBites.detail.subDetail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:AnimalBites.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:AnimalBites.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:AnimalBites.detail.subDetail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:AnimalBites.detail.subDetail.net 0..1 Money Total item cost
Claim.Slices for item.item:AnimalBites.detail.subDetail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:TBDOTS 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:TBDOTS.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:TBDOTS.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:TBDOTS.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:TBDOTS.careTeamSequence 0..* positiveInt Applicable careTeam members
Claim.Slices for item.item:TBDOTS.diagnosisSequence 0..* positiveInt Applicable diagnoses
Claim.Slices for item.item:TBDOTS.procedureSequence 0..* positiveInt Applicable procedures
Claim.Slices for item.item:TBDOTS.informationSequence 0..* positiveInt Applicable exception and supporting information
Claim.Slices for item.item:TBDOTS.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:TBDOTS.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:TBDOTS.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: PatientRelationshipType (required)
Claim.Slices for item.item:TBDOTS.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.
Claim.Slices for item.item:TBDOTS.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:TBDOTS.serviced[x] 0..1 Date or dates of service or product delivery
Claim.Slices for item.item:TBDOTS.serviced[x].servicedDate date
Claim.Slices for item.item:TBDOTS.serviced[x].servicedPeriod Period
Claim.Slices for item.item:TBDOTS.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.Slices for item.item:TBDOTS.location[x].locationCodeableConcept CodeableConcept
Claim.Slices for item.item:TBDOTS.location[x].locationAddress Address
Claim.Slices for item.item:TBDOTS.location[x].locationReference Reference(Location)
Claim.Slices for item.item:TBDOTS.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:TBDOTS.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:TBDOTS.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:TBDOTS.net 0..1 Money Total item cost
Claim.Slices for item.item:TBDOTS.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:TBDOTS.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.Slices for item.item:TBDOTS.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.Slices for item.item:TBDOTS.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.Slices for item.item:TBDOTS.detail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.detail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:TBDOTS.detail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:TBDOTS.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:TBDOTS.detail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:TBDOTS.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:TBDOTS.detail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:TBDOTS.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:TBDOTS.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:TBDOTS.detail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:TBDOTS.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:TBDOTS.detail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:TBDOTS.detail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:TBDOTS.detail.net 0..1 Money Total item cost
Claim.Slices for item.item:TBDOTS.detail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:TBDOTS.detail.subDetail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.detail.subDetail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:TBDOTS.detail.subDetail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:TBDOTS.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:TBDOTS.detail.subDetail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:TBDOTS.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:TBDOTS.detail.subDetail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:TBDOTS.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:TBDOTS.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:TBDOTS.detail.subDetail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:TBDOTS.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:TBDOTS.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:TBDOTS.detail.subDetail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:TBDOTS.detail.subDetail.net 0..1 Money Total item cost
Claim.Slices for item.item:TBDOTS.detail.subDetail.udi 0..* Reference(Device) Unique device identifier
Claim.total 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Claim.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 v7.4
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.
Claim.item:AnimalBites.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​productOrService Base required MaritalStatus 📦4.0.1 FHIR Std.
Claim.item:AnimalBites.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.productOrService Base required Patient relationship type 📦4.0.1 FHIR Std.
Claim.item:TBDOTS.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​subDetail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​subDetail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​subDetail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.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()
sqty-1 error Claim.item.quantity, Claim.item.detail.quantity, Claim.item.detail.subDetail.quantity, Claim.item:AnimalBites.quantity, Claim.item:AnimalBites.detail.quantity, Claim.item:AnimalBites.detail.subDetail.quantity, Claim.item:TBDOTS.quantity, Claim.item:TBDOTS.detail.quantity, Claim.item:TBDOTS.detail.subDetail.quantity The comparator is not used on a SimpleQuantity comparator.empty()

This structure is derived from Claim

Summary

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.item (Closed)

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim 0..* Claim Information about an individual receiving health care services
Claim.id This element is included in summaries. 0..1 id test
Claim.meta This element is included in summaries. 0..1 Meta test
Claim.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri test
Claim.language 0..1 code test
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Claim.text 0..1 Narrative test
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.contained 0..* Resource test
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type This element is included in summaries. 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.use This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient This element is included in summaries. 1..1 Reference(Patient) The recipient of the products and services
Claim.created This element is included in summaries. 1..1 dateTime Resource creation date
Claim.provider This element is included in summaries. 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.insurance This element is included in summaries. 1..* BackboneElement Patient insurance information
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(Coverage) Insurance information
Claim.Slices for item 0..* BackboneElement Product or service provided
Slice: Unordered, Closed by value:productOrService

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for item.item:All Slices Content/Rules for all slices
Claim.Slices for item.item:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:All Slices.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:All Slices.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:AnimalBites 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:AnimalBites.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:AnimalBites.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Marital Status Codes (required)
Claim.Slices for item.item:TBDOTS 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:TBDOTS.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:TBDOTS.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: PatientRelationshipType (required)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​productOrService Base required MaritalStatus 📦4.0.1 FHIR Std.
Claim.item:TBDOTS.productOrService Base required Patient relationship type 📦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: doco
Claim 0..* Claim Information about an individual receiving health care services
Claim.id 0..1 id test
Claim.meta 0..1 Meta test
Claim.implicitRules 0..1 uri test
Claim.language 0..1 code test
Claim.text 0..1 Narrative test
Claim.contained 0..* Resource test
Claim.Slices for item 0..* BackboneElement Product or service provided
Slice: Unordered, Closed by value:productOrService
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for item.item:AnimalBites 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Marital Status Codes (required)
Claim.Slices for item.item:TBDOTS 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: PatientRelationshipType (required)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.item:AnimalBites.​productOrService Base required MaritalStatus 📦4.0.1 FHIR Std.
Claim.item:TBDOTS.productOrService Base required Patient relationship type 📦4.0.1 FHIR Std.

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim 0..* Claim Information about an individual receiving health care services
Claim.id This element is included in summaries. 0..1 id test
Claim.meta This element is included in summaries. 0..1 Meta test
Claim.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri test
Claim.language 0..1 code test
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Claim.text 0..1 Narrative test
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.contained 0..* Resource test
Claim.extension 0..* Extension Additional content defined by implementations
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier 0..* Identifier Business Identifier for claim
Claim.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type This element is included in summaries. 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.use This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient This element is included in summaries. 1..1 Reference(Patient) The recipient of the products and services
Claim.billablePeriod This element is included in summaries. 0..1 Period Relevant time frame for the claim
Claim.created This element is included in summaries. 1..1 dateTime Resource creation date
Claim.enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
Claim.insurer This element is included in summaries. 0..1 Reference(Organization) Target
Claim.provider This element is included in summaries. 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related 0..* BackboneElement Prior or corollary claims
Claim.related.id 0..1 string Unique id for inter-element referencing
Claim.related.extension 0..* Extension Additional content defined by implementations
Claim.related.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.related.claim 0..1 Reference(Claim) Reference to the related claim
Claim.related.relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference 0..1 Identifier File or case reference
Claim.prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
Claim.originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
Claim.payee 0..1 BackboneElement Recipient of benefits payable
Claim.payee.id 0..1 string Unique id for inter-element referencing
Claim.payee.extension 0..* Extension Additional content defined by implementations
Claim.payee.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.payee.type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.payee.party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
Claim.referral 0..1 Reference(ServiceRequest) Treatment referral
Claim.facility 0..1 Reference(Location) Servicing facility
Claim.careTeam 0..* BackboneElement Members of the care team
Claim.careTeam.id 0..1 string Unique id for inter-element referencing
Claim.careTeam.extension 0..* Extension Additional content defined by implementations
Claim.careTeam.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.careTeam.sequence 1..1 positiveInt Order of care team
Claim.careTeam.provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
Claim.careTeam.responsible 0..1 boolean Indicator of the lead practitioner
Claim.careTeam.role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.careTeam.qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.supportingInfo 0..* BackboneElement Supporting information
Claim.supportingInfo.id 0..1 string Unique id for inter-element referencing
Claim.supportingInfo.extension 0..* Extension Additional content defined by implementations
Claim.supportingInfo.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence 1..1 positiveInt Information instance identifier
Claim.supportingInfo.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.supportingInfo.timing[x] 0..1 When it occurred
Claim.supportingInfo.timing[x].timingDate date
Claim.supportingInfo.timing[x].timingPeriod Period
Claim.supportingInfo.value[x] 0..1 Data to be provided
Claim.supportingInfo.value[x].valueBoolean boolean
Claim.supportingInfo.value[x].valueString string
Claim.supportingInfo.value[x].valueQuantity Quantity
Claim.supportingInfo.value[x].valueAttachment Attachment
Claim.supportingInfo.value[x].valueReference Reference(Resource)
Claim.supportingInfo.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis 0..* BackboneElement Pertinent diagnosis information
Claim.diagnosis.id 0..1 string Unique id for inter-element referencing
Claim.diagnosis.extension 0..* Extension Additional content defined by implementations
Claim.diagnosis.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence 1..1 positiveInt Diagnosis instance identifier
Claim.diagnosis.diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference Reference(Condition)
Claim.diagnosis.type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
Claim.diagnosis.packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Claim.procedure 0..* BackboneElement Clinical procedures performed
Claim.procedure.id 0..1 string Unique id for inter-element referencing
Claim.procedure.extension 0..* Extension Additional content defined by implementations
Claim.procedure.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence 1..1 positiveInt Procedure instance identifier
Claim.procedure.type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
Claim.procedure.date 0..1 dateTime When the procedure was performed
Claim.procedure.procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept CodeableConcept
Claim.procedure.procedure[x].procedureReference Reference(Procedure)
Claim.procedure.udi 0..* Reference(Device) Unique device identifier
Claim.insurance This element is included in summaries. 1..* BackboneElement Patient insurance information
Claim.insurance.id 0..1 string Unique id for inter-element referencing
Claim.insurance.extension 0..* Extension Additional content defined by implementations
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
Claim.insurance.identifier 0..1 Identifier Pre-assigned Claim number
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(Coverage) Insurance information
Claim.insurance.businessArrangement 0..1 string Additional provider contract number
Claim.insurance.preAuthRef 0..* string Prior authorization reference number
Claim.insurance.claimResponse 0..1 Reference(ClaimResponse) Adjudication results
Claim.accident 0..1 BackboneElement Details of the event
Claim.accident.id 0..1 string Unique id for inter-element referencing
Claim.accident.extension 0..* Extension Additional content defined by implementations
Claim.accident.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.accident.date 1..1 date When the incident occurred
Claim.accident.type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x] 0..1 Where the event occurred
Claim.accident.location[x].locationAddress Address
Claim.accident.location[x].locationReference Reference(Location)
Claim.Slices for item 0..* BackboneElement Product or service provided
Slice: Unordered, Closed by value:productOrService

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for item.item:All Slices Content/Rules for all slices
Claim.Slices for item.item:All Slices.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:All Slices.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:All Slices.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:All Slices.careTeamSequence 0..* positiveInt Applicable careTeam members
Claim.Slices for item.item:All Slices.diagnosisSequence 0..* positiveInt Applicable diagnoses
Claim.Slices for item.item:All Slices.procedureSequence 0..* positiveInt Applicable procedures
Claim.Slices for item.item:All Slices.informationSequence 0..* positiveInt Applicable exception and supporting information
Claim.Slices for item.item:All Slices.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:All Slices.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:All Slices.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:All Slices.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.
Claim.Slices for item.item:All Slices.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:All Slices.serviced[x] 0..1 Date or dates of service or product delivery
Claim.Slices for item.item:All Slices.serviced[x].servicedDate date
Claim.Slices for item.item:All Slices.serviced[x].servicedPeriod Period
Claim.Slices for item.item:All Slices.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.Slices for item.item:All Slices.location[x].locationCodeableConcept CodeableConcept
Claim.Slices for item.item:All Slices.location[x].locationAddress Address
Claim.Slices for item.item:All Slices.location[x].locationReference Reference(Location)
Claim.Slices for item.item:All Slices.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:All Slices.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:All Slices.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:All Slices.net 0..1 Money Total item cost
Claim.Slices for item.item:All Slices.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:All Slices.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.Slices for item.item:All Slices.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.Slices for item.item:All Slices.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.Slices for item.item:All Slices.detail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:All Slices.detail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:All Slices.detail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:All Slices.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:All Slices.detail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:All Slices.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:All Slices.detail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:All Slices.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:All Slices.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:All Slices.detail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:All Slices.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:All Slices.detail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:All Slices.detail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:All Slices.detail.net 0..1 Money Total item cost
Claim.Slices for item.item:All Slices.detail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:All Slices.detail.subDetail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:All Slices.detail.subDetail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:All Slices.detail.subDetail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:All Slices.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:All Slices.detail.subDetail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:All Slices.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:All Slices.detail.subDetail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:All Slices.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:All Slices.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:All Slices.detail.subDetail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:All Slices.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:All Slices.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:All Slices.detail.subDetail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:All Slices.detail.subDetail.net 0..1 Money Total item cost
Claim.Slices for item.item:All Slices.detail.subDetail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:AnimalBites 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:AnimalBites.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:AnimalBites.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:AnimalBites.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:AnimalBites.careTeamSequence 0..* positiveInt Applicable careTeam members
Claim.Slices for item.item:AnimalBites.diagnosisSequence 0..* positiveInt Applicable diagnoses
Claim.Slices for item.item:AnimalBites.procedureSequence 0..* positiveInt Applicable procedures
Claim.Slices for item.item:AnimalBites.informationSequence 0..* positiveInt Applicable exception and supporting information
Claim.Slices for item.item:AnimalBites.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:AnimalBites.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:AnimalBites.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Marital Status Codes (required)
Claim.Slices for item.item:AnimalBites.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.
Claim.Slices for item.item:AnimalBites.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:AnimalBites.serviced[x] 0..1 Date or dates of service or product delivery
Claim.Slices for item.item:AnimalBites.serviced[x].servicedDate date
Claim.Slices for item.item:AnimalBites.serviced[x].servicedPeriod Period
Claim.Slices for item.item:AnimalBites.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.Slices for item.item:AnimalBites.location[x].locationCodeableConcept CodeableConcept
Claim.Slices for item.item:AnimalBites.location[x].locationAddress Address
Claim.Slices for item.item:AnimalBites.location[x].locationReference Reference(Location)
Claim.Slices for item.item:AnimalBites.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:AnimalBites.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:AnimalBites.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:AnimalBites.net 0..1 Money Total item cost
Claim.Slices for item.item:AnimalBites.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:AnimalBites.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.Slices for item.item:AnimalBites.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.Slices for item.item:AnimalBites.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.Slices for item.item:AnimalBites.detail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.detail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:AnimalBites.detail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:AnimalBites.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:AnimalBites.detail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:AnimalBites.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:AnimalBites.detail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:AnimalBites.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:AnimalBites.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:AnimalBites.detail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:AnimalBites.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:AnimalBites.detail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:AnimalBites.detail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:AnimalBites.detail.net 0..1 Money Total item cost
Claim.Slices for item.item:AnimalBites.detail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:AnimalBites.detail.subDetail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:AnimalBites.detail.subDetail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:AnimalBites.detail.subDetail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:AnimalBites.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:AnimalBites.detail.subDetail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:AnimalBites.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:AnimalBites.detail.subDetail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:AnimalBites.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:AnimalBites.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:AnimalBites.detail.subDetail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:AnimalBites.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:AnimalBites.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:AnimalBites.detail.subDetail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:AnimalBites.detail.subDetail.net 0..1 Money Total item cost
Claim.Slices for item.item:AnimalBites.detail.subDetail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:TBDOTS 0..1 BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:TBDOTS.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:TBDOTS.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:TBDOTS.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:TBDOTS.careTeamSequence 0..* positiveInt Applicable careTeam members
Claim.Slices for item.item:TBDOTS.diagnosisSequence 0..* positiveInt Applicable diagnoses
Claim.Slices for item.item:TBDOTS.procedureSequence 0..* positiveInt Applicable procedures
Claim.Slices for item.item:TBDOTS.informationSequence 0..* positiveInt Applicable exception and supporting information
Claim.Slices for item.item:TBDOTS.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:TBDOTS.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:TBDOTS.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: PatientRelationshipType (required)
Claim.Slices for item.item:TBDOTS.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.
Claim.Slices for item.item:TBDOTS.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:TBDOTS.serviced[x] 0..1 Date or dates of service or product delivery
Claim.Slices for item.item:TBDOTS.serviced[x].servicedDate date
Claim.Slices for item.item:TBDOTS.serviced[x].servicedPeriod Period
Claim.Slices for item.item:TBDOTS.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.Slices for item.item:TBDOTS.location[x].locationCodeableConcept CodeableConcept
Claim.Slices for item.item:TBDOTS.location[x].locationAddress Address
Claim.Slices for item.item:TBDOTS.location[x].locationReference Reference(Location)
Claim.Slices for item.item:TBDOTS.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:TBDOTS.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:TBDOTS.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:TBDOTS.net 0..1 Money Total item cost
Claim.Slices for item.item:TBDOTS.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:TBDOTS.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.Slices for item.item:TBDOTS.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.Slices for item.item:TBDOTS.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.Slices for item.item:TBDOTS.detail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.detail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:TBDOTS.detail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:TBDOTS.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:TBDOTS.detail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:TBDOTS.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:TBDOTS.detail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:TBDOTS.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:TBDOTS.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:TBDOTS.detail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:TBDOTS.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:TBDOTS.detail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:TBDOTS.detail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:TBDOTS.detail.net 0..1 Money Total item cost
Claim.Slices for item.item:TBDOTS.detail.udi 0..* Reference(Device) Unique device identifier
Claim.Slices for item.item:TBDOTS.detail.subDetail 0..* BackboneElement Product or service provided
Claim.Slices for item.item:TBDOTS.detail.subDetail.id 0..1 string Unique id for inter-element referencing
Claim.Slices for item.item:TBDOTS.detail.subDetail.extension 0..* Extension Additional content defined by implementations
Claim.Slices for item.item:TBDOTS.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.Slices for item.item:TBDOTS.detail.subDetail.sequence 1..1 positiveInt Item instance identifier
Claim.Slices for item.item:TBDOTS.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.Slices for item.item:TBDOTS.detail.subDetail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.Slices for item.item:TBDOTS.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.Slices for item.item:TBDOTS.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.Slices for item.item:TBDOTS.detail.subDetail.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.Slices for item.item:TBDOTS.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.Slices for item.item:TBDOTS.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item
Claim.Slices for item.item:TBDOTS.detail.subDetail.factor 0..1 decimal Price scaling factor
Claim.Slices for item.item:TBDOTS.detail.subDetail.net 0..1 Money Total item cost
Claim.Slices for item.item:TBDOTS.detail.subDetail.udi 0..* Reference(Device) Unique device identifier
Claim.total 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Claim.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 v7.4
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.
Claim.item:AnimalBites.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​productOrService Base required MaritalStatus 📦4.0.1 FHIR Std.
Claim.item:AnimalBites.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:AnimalBites.​detail.subDetail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.productOrService Base required Patient relationship type 📦4.0.1 FHIR Std.
Claim.item:TBDOTS.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​subDetail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​subDetail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​subDetail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.detail.​subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item:TBDOTS.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()
sqty-1 error Claim.item.quantity, Claim.item.detail.quantity, Claim.item.detail.subDetail.quantity, Claim.item:AnimalBites.quantity, Claim.item:AnimalBites.detail.quantity, Claim.item:AnimalBites.detail.subDetail.quantity, Claim.item:TBDOTS.quantity, Claim.item:TBDOTS.detail.quantity, Claim.item:TBDOTS.detail.subDetail.quantity The comparator is not used on a SimpleQuantity comparator.empty()

This structure is derived from Claim

Summary

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.item (Closed)

 

Other representations of profile: CSV, Excel, Schematron