Belgian MyCareNet eTariff Profiles
1.0.0 - STU
Belgian MyCareNet eTariff Profiles, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/etariff/ and changes regularly. See the Directory of published versions
Official URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-etariff-claim | Version: 1.0.0 | |||
Draft as of 2024-10-02 | Computable Name: BeEtariffClaim |
Claim profile for use in the different Etariff flows from MyCareNet
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Claim
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-inv-gmf-holder: GMF holder CAN only occur in a GP's attestation be-inv-related: A related/relative service SHALL NOT occur in general practice be-inv-toothnumber: A toothnumber SHALL NOT occur in general practice |
status | 1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active | |
type | S | 1..1 | CodeableConcept | Category or discipline |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
subType | S | 1..1 | CodeableConcept | More granular claim type Binding: eTariff types (extensible) |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
use | S | 1..1 | code | claim | preauthorization | predetermination Required Pattern: predetermination |
patient | S | 1..1 | Reference(BePatient) | The recipient of the products and services |
created | S | 1..1 | dateTime | Resource creation date |
enterer | S | 1..1 | Reference(BePractitionerRole) | Author of the claim |
provider | S | 1..1 | Reference(BePractitionerRole | BeOrganization) | Party responsible for the claim |
priority | S | 1..1 | CodeableConcept | Desired processing ugency |
coding | S | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
careTeam | S | 1..* | BackboneElement | Members of the care team |
sequence | S | 1..1 | positiveInt | Order of care team |
provider | S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization |
identifier | S | 1..1 | Identifier | Logical reference, when literal reference is not known |
system | S | 1..1 | uri | The namespace for the identifier value Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi |
value | S | 1..1 | string | The value that is unique |
role | S | 1..1 | CodeableConcept | Function within the team |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
qualification | S | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: BeVSCdHcParty (required) |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
supportingInfo | S | 0..* | BackboneElement | Supporting information |
code | S | 0..1 | CodeableConcept | Type of information |
Slices for value[x] | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided Slice: Unordered, Open by type:$this | |
value[x]:valueReference | S | 0..1 | Reference(Resource) | Data to be provided |
insurance | ||||
sequence | 1..1 | positiveInt | Insurance instance identifier Required Pattern: 1 | |
focal | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | |
coverage | ||||
display | 0..1 | string | Text alternative for the resource Required Pattern: use of mandatory insurance coverage, no further details provided here. | |
item | S | 1..* | BackboneElement | Product or service provided |
sequence | S | 1..1 | positiveInt | Item instance identifier |
careTeamSequence | S | 1..* | positiveInt | Applicable careTeam members |
informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information |
productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature |
code | S | 1..1 | code | Symbol in syntax defined by the system |
Slices for serviced[x] | 1..1 | date | Date or dates of service or product delivery Slice: Unordered, Open by type:$this | |
serviced[x]:servicedDate | S | 1..1 | date | Date or dates of service or product delivery |
bodySite | S | 0..1 | CodeableConcept | Anatomical location Binding: Body Site (required) |
coding | S | 0..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
total | 0..0 | |||
Documentation for this format |
Path | Conformance | ValueSet | URI |
Claim.subType | extensible | BeVSEtariffTypes (a valid code from eTariff types)https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG | |
Claim.careTeam.qualification | required | BeVSCdHcPartyhttps://www.ehealth.fgov.be/standards/fhir/core/ValueSet/be-vs-cd-hcparty | |
Claim.item.bodySite | required | BeVSBodySitehttps://www.ehealth.fgov.be/standards/fhir/core-clinical/ValueSet/be-vs-bodysite |
Id | Grade | Path(s) | Details | Requirements |
be-inv-gmf-holder | error | Claim | GMF holder CAN only occur in a GP's attestation : Claim.subType.coding.where(code = 'generalpractice').empty() implies Claim.careTeam.where(role.coding.code = 'other').where(qualification.coding.code = 'persphysician').empty() | |
be-inv-related | error | Claim | A related/relative service SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies Claim.supportingInfo.code.coding.where(system = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/NamingSystem/be-ns-claim-related-claim').empty() | |
be-inv-toothnumber | error | Claim | A toothnumber SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies (Claim.item.bodySite.empty() or Claim.item.bodySite.coding.memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-toothnumber-bodysite').not()) |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-inv-gmf-holder: GMF holder CAN only occur in a GP's attestation be-inv-related: A related/relative service SHALL NOT occur in general practice be-inv-toothnumber: A toothnumber SHALL NOT occur in general practice |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active |
type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
subType | S | 1..1 | CodeableConcept | More granular claim type Binding: eTariff types (extensible) |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination |
patient | SΣ | 1..1 | Reference(BePatient) | The recipient of the products and services |
created | SΣ | 1..1 | dateTime | Resource creation date |
enterer | S | 1..1 | Reference(BePractitionerRole) | Author of the claim |
provider | SΣ | 1..1 | Reference(BePractitionerRole | BeOrganization) | Party responsible for the claim |
priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
careTeam | S | 1..* | BackboneElement | Members of the care team |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S | 1..1 | positiveInt | Order of care team |
provider | S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization |
identifier | SΣ | 1..1 | Identifier | Logical reference, when literal reference is not known |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
system | SΣ | 1..1 | uri | The namespace for the identifier value Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi |
value | SΣ | 1..1 | string | The value that is unique Example General: 123456 |
role | S | 1..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
qualification | S | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: BeVSCdHcParty (required) |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
supportingInfo | S | 0..* | BackboneElement | Supporting information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |
code | S | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. |
Slices for value[x] | 0..1 | Data to be provided Slice: Unordered, Open by type:$this | ||
valueBoolean | boolean | |||
valueString | string | |||
valueQuantity | Quantity | |||
valueAttachment | Attachment | |||
valueReference | Reference(Resource) | |||
value[x]:valueReference | S | 0..1 | Reference(Resource) | Data to be provided |
insurance | Σ | 1..* | BackboneElement | Patient insurance information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier Required Pattern: 1 |
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true |
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information |
display | Σ | 0..1 | string | Text alternative for the resource Required Pattern: use of mandatory insurance coverage, no further details provided here. |
item | S | 1..* | BackboneElement | Product or service provided |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S | 1..1 | positiveInt | Item instance identifier |
careTeamSequence | S | 1..* | positiveInt | Applicable careTeam members |
informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information |
productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
Slices for serviced[x] | 1..1 | date | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |
serviced[x]:servicedDate | S | 1..1 | date | Date or dates of service or product delivery |
bodySite | S | 0..1 | CodeableConcept | Anatomical location Binding: Body Site (required) |
coding | SΣ | 0..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
Documentation for this format |
Path | Conformance | ValueSet / Code | URI |
Claim.status | required | Pattern: activehttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | |
Claim.subType | extensible | BeVSEtariffTypes (a valid code from eTariff types)https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG | |
Claim.use | required | Pattern: predeterminationhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | |
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard | |
Claim.careTeam.provider.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard | |
Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole from the FHIR Standard | |
Claim.careTeam.qualification | required | BeVSCdHcPartyhttps://www.ehealth.fgov.be/standards/fhir/core/ValueSet/be-vs-cd-hcparty | |
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory from the FHIR Standard | |
Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception from the FHIR Standard | |
Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | |
Claim.item.bodySite | required | BeVSBodySitehttps://www.ehealth.fgov.be/standards/fhir/core-clinical/ValueSet/be-vs-bodysite |
Id | Grade | Path(s) | Details | Requirements |
be-inv-gmf-holder | error | Claim | GMF holder CAN only occur in a GP's attestation : Claim.subType.coding.where(code = 'generalpractice').empty() implies Claim.careTeam.where(role.coding.code = 'other').where(qualification.coding.code = 'persphysician').empty() | |
be-inv-related | error | Claim | A related/relative service SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies Claim.supportingInfo.code.coding.where(system = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/NamingSystem/be-ns-claim-related-claim').empty() | |
be-inv-toothnumber | error | Claim | A toothnumber SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies (Claim.item.bodySite.empty() or Claim.item.bodySite.coding.memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-toothnumber-bodysite').not()) | |
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() |
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-inv-gmf-holder: GMF holder CAN only occur in a GP's attestation be-inv-related: A related/relative service SHALL NOT occur in general practice be-inv-toothnumber: A toothnumber SHALL NOT occur in general practice | ||||
id | Σ | 0..1 | id | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | 0..* | Identifier | Business Identifier for claim | |||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active | ||||
type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
subType | S | 1..1 | CodeableConcept | More granular claim type Binding: eTariff types (extensible) | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination | ||||
patient | SΣ | 1..1 | Reference(BePatient) | The recipient of the products and services | ||||
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim | ||||
created | SΣ | 1..1 | dateTime | Resource creation date | ||||
enterer | S | 1..1 | Reference(BePractitionerRole) | Author of the claim | ||||
insurer | Σ | 0..1 | Reference(Organization) | Target | ||||
provider | SΣ | 1..1 | Reference(BePractitionerRole | BeOrganization) | Party responsible for the claim | ||||
priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | |||||
display | 0..1 | string | Representation defined by the system | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
related | 0..* | BackboneElement | Prior or corollary claims | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||
relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||
reference | 0..1 | Identifier | File or case reference | |||||
prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||
originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||
payee | 0..1 | BackboneElement | Recipient of benefits payable | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
party | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
referral | 0..1 | Reference(ServiceRequest) | Treatment referral | |||||
facility | 0..1 | Reference(Location) | Servicing facility | |||||
careTeam | S | 1..* | BackboneElement | Members of the care team | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | S | 1..1 | positiveInt | Order of care team | ||||
provider | S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
identifier | SΣ | 1..1 | Identifier | Logical reference, when literal reference is not known | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
system | SΣ | 1..1 | uri | The namespace for the identifier value Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi | ||||
value | SΣ | 1..1 | string | The value that is unique Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
display | Σ | 0..1 | string | Text alternative for the resource | ||||
responsible | 0..1 | boolean | Indicator of the lead practitioner | |||||
role | S | 1..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
qualification | S | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: BeVSCdHcParty (required) | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
supportingInfo | S | 0..* | BackboneElement | Supporting information | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |||||
code | S | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | ||||
timing[x] | 0..1 | When it occurred | ||||||
timingDate | date | |||||||
timingPeriod | Period | |||||||
Slices for value[x] | 0..1 | Data to be provided Slice: Unordered, Open by type:$this | ||||||
valueBoolean | boolean | |||||||
valueString | string | |||||||
valueQuantity | Quantity | |||||||
valueAttachment | Attachment | |||||||
valueReference | Reference(Resource) | |||||||
value[x]:valueReference | S | 0..1 | Reference(Resource) | Data to be provided | ||||
reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
diagnosis | 0..* | BackboneElement | Pertinent diagnosis information | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Diagnosis instance identifier | |||||
diagnosis[x] | 1..1 | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||||||
diagnosisCodeableConcept | CodeableConcept | |||||||
diagnosisReference | Reference(Condition) | |||||||
type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. | |||||
onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||
packageCode | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||
procedure | 0..* | BackboneElement | Clinical procedures performed | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Procedure instance identifier | |||||
type | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||
date | 0..1 | dateTime | When the procedure was performed | |||||
procedure[x] | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||||||
procedureCodeableConcept | CodeableConcept | |||||||
procedureReference | Reference(Procedure) | |||||||
udi | 0..* | Reference(Device) | Unique device identifier | |||||
insurance | Σ | 1..* | BackboneElement | Patient insurance information | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier Required Pattern: 1 | ||||
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | ||||
identifier | 0..1 | Identifier | Pre-assigned Claim number | |||||
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
display | Σ | 0..1 | string | Text alternative for the resource Required Pattern: use of mandatory insurance coverage, no further details provided here. | ||||
businessArrangement | 0..1 | string | Additional provider contract number | |||||
preAuthRef | 0..* | string | Prior authorization reference number | |||||
claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||
accident | 0..1 | BackboneElement | Details of the event | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
date | 1..1 | date | When the incident occurred | |||||
type | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |||||
location[x] | 0..1 | Where the event occurred | ||||||
locationAddress | Address | |||||||
locationReference | Reference(Location) | |||||||
item | S | 1..* | BackboneElement | Product or service provided | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | S | 1..1 | positiveInt | Item instance identifier | ||||
careTeamSequence | S | 1..* | positiveInt | Applicable careTeam members | ||||
diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | |||||
procedureSequence | 0..* | positiveInt | Applicable procedures | |||||
informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information | ||||
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
Slices for serviced[x] | 1..1 | date | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |||||
serviced[x]:servicedDate | S | 1..1 | date | Date or dates of service or product delivery | ||||
location[x] | 0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
locationCodeableConcept | CodeableConcept | |||||||
locationAddress | Address | |||||||
locationReference | Reference(Location) | |||||||
quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
factor | 0..1 | decimal | Price scaling factor | |||||
net | 0..1 | Money | Total item cost | |||||
udi | 0..* | Reference(Device) | Unique device identifier | |||||
bodySite | S | 0..1 | CodeableConcept | Anatomical location Binding: Body Site (required) | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 0..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||
detail | 0..* | BackboneElement | Product or service provided | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Item instance identifier | |||||
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
factor | 0..1 | decimal | Price scaling factor | |||||
net | 0..1 | Money | Total item cost | |||||
udi | 0..* | Reference(Device) | Unique device identifier | |||||
subDetail | 0..* | BackboneElement | Product or service provided | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Item instance identifier | |||||
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
factor | 0..1 | decimal | Price scaling factor | |||||
net | 0..1 | Money | Total item cost | |||||
udi | 0..* | Reference(Device) | Unique device identifier | |||||
Documentation for this format |
Path | Conformance | ValueSet / Code | URI | |||
Claim.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
Claim.status | required | Pattern: activehttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | ||||
Claim.subType | extensible | BeVSEtariffTypes (a valid code from eTariff types)https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG | ||||
Claim.use | required | Pattern: predeterminationhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | ||||
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard | ||||
Claim.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard | ||||
Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationship from the FHIR Standard | ||||
Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard | ||||
Claim.careTeam.provider.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard | ||||
Claim.careTeam.provider.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard | ||||
Claim.careTeam.provider.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard | ||||
Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole from the FHIR Standard | ||||
Claim.careTeam.qualification | required | BeVSCdHcPartyhttps://www.ehealth.fgov.be/standards/fhir/core/ValueSet/be-vs-cd-hcparty | ||||
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory from the FHIR Standard | ||||
Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception from the FHIR Standard | ||||
Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reason from the FHIR Standard | ||||
Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard | ||||
Claim.diagnosis.type | example | ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype from the FHIR Standard | ||||
Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission from the FHIR Standard | ||||
Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup from the FHIR Standard | ||||
Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type from the FHIR Standard | ||||
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures from the FHIR Standard | ||||
Claim.insurance.coverage.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard | ||||
Claim.accident.type | extensible | ActIncidentCodehttp://terminology.hl7.org/ValueSet/v3-ActIncidentCode | ||||
Claim.item.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
Claim.item.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-place from the FHIR Standard | ||||
Claim.item.bodySite | required | BeVSBodySitehttps://www.ehealth.fgov.be/standards/fhir/core-clinical/ValueSet/be-vs-bodysite | ||||
Claim.item.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surface from the FHIR Standard | ||||
Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
be-inv-gmf-holder | error | Claim | GMF holder CAN only occur in a GP's attestation : Claim.subType.coding.where(code = 'generalpractice').empty() implies Claim.careTeam.where(role.coding.code = 'other').where(qualification.coding.code = 'persphysician').empty() | |
be-inv-related | error | Claim | A related/relative service SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies Claim.supportingInfo.code.coding.where(system = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/NamingSystem/be-ns-claim-related-claim').empty() | |
be-inv-toothnumber | error | Claim | A toothnumber SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies (Claim.item.bodySite.empty() or Claim.item.bodySite.coding.memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-toothnumber-bodysite').not()) | |
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Claim
Summary
Mandatory: 30 elements(2 nested mandatory elements)
Must-Support: 47 elements
Prohibited: 1 element
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from Claim
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-inv-gmf-holder: GMF holder CAN only occur in a GP's attestation be-inv-related: A related/relative service SHALL NOT occur in general practice be-inv-toothnumber: A toothnumber SHALL NOT occur in general practice |
status | 1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active | |
type | S | 1..1 | CodeableConcept | Category or discipline |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
subType | S | 1..1 | CodeableConcept | More granular claim type Binding: eTariff types (extensible) |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
use | S | 1..1 | code | claim | preauthorization | predetermination Required Pattern: predetermination |
patient | S | 1..1 | Reference(BePatient) | The recipient of the products and services |
created | S | 1..1 | dateTime | Resource creation date |
enterer | S | 1..1 | Reference(BePractitionerRole) | Author of the claim |
provider | S | 1..1 | Reference(BePractitionerRole | BeOrganization) | Party responsible for the claim |
priority | S | 1..1 | CodeableConcept | Desired processing ugency |
coding | S | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
careTeam | S | 1..* | BackboneElement | Members of the care team |
sequence | S | 1..1 | positiveInt | Order of care team |
provider | S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization |
identifier | S | 1..1 | Identifier | Logical reference, when literal reference is not known |
system | S | 1..1 | uri | The namespace for the identifier value Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi |
value | S | 1..1 | string | The value that is unique |
role | S | 1..1 | CodeableConcept | Function within the team |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
qualification | S | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: BeVSCdHcParty (required) |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
supportingInfo | S | 0..* | BackboneElement | Supporting information |
code | S | 0..1 | CodeableConcept | Type of information |
Slices for value[x] | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided Slice: Unordered, Open by type:$this | |
value[x]:valueReference | S | 0..1 | Reference(Resource) | Data to be provided |
insurance | ||||
sequence | 1..1 | positiveInt | Insurance instance identifier Required Pattern: 1 | |
focal | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | |
coverage | ||||
display | 0..1 | string | Text alternative for the resource Required Pattern: use of mandatory insurance coverage, no further details provided here. | |
item | S | 1..* | BackboneElement | Product or service provided |
sequence | S | 1..1 | positiveInt | Item instance identifier |
careTeamSequence | S | 1..* | positiveInt | Applicable careTeam members |
informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information |
productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code |
coding | S | 1..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature |
code | S | 1..1 | code | Symbol in syntax defined by the system |
Slices for serviced[x] | 1..1 | date | Date or dates of service or product delivery Slice: Unordered, Open by type:$this | |
serviced[x]:servicedDate | S | 1..1 | date | Date or dates of service or product delivery |
bodySite | S | 0..1 | CodeableConcept | Anatomical location Binding: Body Site (required) |
coding | S | 0..1 | Coding | Code defined by a terminology system |
system | S | 1..1 | uri | Identity of the terminology system |
code | S | 1..1 | code | Symbol in syntax defined by the system |
total | 0..0 | |||
Documentation for this format |
Path | Conformance | ValueSet | URI |
Claim.subType | extensible | BeVSEtariffTypes (a valid code from eTariff types)https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG | |
Claim.careTeam.qualification | required | BeVSCdHcPartyhttps://www.ehealth.fgov.be/standards/fhir/core/ValueSet/be-vs-cd-hcparty | |
Claim.item.bodySite | required | BeVSBodySitehttps://www.ehealth.fgov.be/standards/fhir/core-clinical/ValueSet/be-vs-bodysite |
Id | Grade | Path(s) | Details | Requirements |
be-inv-gmf-holder | error | Claim | GMF holder CAN only occur in a GP's attestation : Claim.subType.coding.where(code = 'generalpractice').empty() implies Claim.careTeam.where(role.coding.code = 'other').where(qualification.coding.code = 'persphysician').empty() | |
be-inv-related | error | Claim | A related/relative service SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies Claim.supportingInfo.code.coding.where(system = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/NamingSystem/be-ns-claim-related-claim').empty() | |
be-inv-toothnumber | error | Claim | A toothnumber SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies (Claim.item.bodySite.empty() or Claim.item.bodySite.coding.memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-toothnumber-bodysite').not()) |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-inv-gmf-holder: GMF holder CAN only occur in a GP's attestation be-inv-related: A related/relative service SHALL NOT occur in general practice be-inv-toothnumber: A toothnumber SHALL NOT occur in general practice |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active |
type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
subType | S | 1..1 | CodeableConcept | More granular claim type Binding: eTariff types (extensible) |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination |
patient | SΣ | 1..1 | Reference(BePatient) | The recipient of the products and services |
created | SΣ | 1..1 | dateTime | Resource creation date |
enterer | S | 1..1 | Reference(BePractitionerRole) | Author of the claim |
provider | SΣ | 1..1 | Reference(BePractitionerRole | BeOrganization) | Party responsible for the claim |
priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
careTeam | S | 1..* | BackboneElement | Members of the care team |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S | 1..1 | positiveInt | Order of care team |
provider | S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization |
identifier | SΣ | 1..1 | Identifier | Logical reference, when literal reference is not known |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
system | SΣ | 1..1 | uri | The namespace for the identifier value Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi |
value | SΣ | 1..1 | string | The value that is unique Example General: 123456 |
role | S | 1..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
qualification | S | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: BeVSCdHcParty (required) |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
supportingInfo | S | 0..* | BackboneElement | Supporting information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |
code | S | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. |
Slices for value[x] | 0..1 | Data to be provided Slice: Unordered, Open by type:$this | ||
valueBoolean | boolean | |||
valueString | string | |||
valueQuantity | Quantity | |||
valueAttachment | Attachment | |||
valueReference | Reference(Resource) | |||
value[x]:valueReference | S | 0..1 | Reference(Resource) | Data to be provided |
insurance | Σ | 1..* | BackboneElement | Patient insurance information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier Required Pattern: 1 |
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true |
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information |
display | Σ | 0..1 | string | Text alternative for the resource Required Pattern: use of mandatory insurance coverage, no further details provided here. |
item | S | 1..* | BackboneElement | Product or service provided |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S | 1..1 | positiveInt | Item instance identifier |
careTeamSequence | S | 1..* | positiveInt | Applicable careTeam members |
informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information |
productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. |
coding | SΣ | 1..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
Slices for serviced[x] | 1..1 | date | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |
serviced[x]:servicedDate | S | 1..1 | date | Date or dates of service or product delivery |
bodySite | S | 0..1 | CodeableConcept | Anatomical location Binding: Body Site (required) |
coding | SΣ | 0..1 | Coding | Code defined by a terminology system |
system | SΣ | 1..1 | uri | Identity of the terminology system |
code | SΣ | 1..1 | code | Symbol in syntax defined by the system |
Documentation for this format |
Path | Conformance | ValueSet / Code | URI |
Claim.status | required | Pattern: activehttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | |
Claim.subType | extensible | BeVSEtariffTypes (a valid code from eTariff types)https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG | |
Claim.use | required | Pattern: predeterminationhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | |
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard | |
Claim.careTeam.provider.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard | |
Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole from the FHIR Standard | |
Claim.careTeam.qualification | required | BeVSCdHcPartyhttps://www.ehealth.fgov.be/standards/fhir/core/ValueSet/be-vs-cd-hcparty | |
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory from the FHIR Standard | |
Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception from the FHIR Standard | |
Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | |
Claim.item.bodySite | required | BeVSBodySitehttps://www.ehealth.fgov.be/standards/fhir/core-clinical/ValueSet/be-vs-bodysite |
Id | Grade | Path(s) | Details | Requirements |
be-inv-gmf-holder | error | Claim | GMF holder CAN only occur in a GP's attestation : Claim.subType.coding.where(code = 'generalpractice').empty() implies Claim.careTeam.where(role.coding.code = 'other').where(qualification.coding.code = 'persphysician').empty() | |
be-inv-related | error | Claim | A related/relative service SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies Claim.supportingInfo.code.coding.where(system = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/NamingSystem/be-ns-claim-related-claim').empty() | |
be-inv-toothnumber | error | Claim | A toothnumber SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies (Claim.item.bodySite.empty() or Claim.item.bodySite.coding.memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-toothnumber-bodysite').not()) | |
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() |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-inv-gmf-holder: GMF holder CAN only occur in a GP's attestation be-inv-related: A related/relative service SHALL NOT occur in general practice be-inv-toothnumber: A toothnumber SHALL NOT occur in general practice | ||||
id | Σ | 0..1 | id | Logical id of this artifact | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | 0..* | Identifier | Business Identifier for claim | |||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active | ||||
type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
subType | S | 1..1 | CodeableConcept | More granular claim type Binding: eTariff types (extensible) | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination | ||||
patient | SΣ | 1..1 | Reference(BePatient) | The recipient of the products and services | ||||
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim | ||||
created | SΣ | 1..1 | dateTime | Resource creation date | ||||
enterer | S | 1..1 | Reference(BePractitionerRole) | Author of the claim | ||||
insurer | Σ | 0..1 | Reference(Organization) | Target | ||||
provider | SΣ | 1..1 | Reference(BePractitionerRole | BeOrganization) | Party responsible for the claim | ||||
priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | |||||
display | 0..1 | string | Representation defined by the system | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
related | 0..* | BackboneElement | Prior or corollary claims | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||
relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||
reference | 0..1 | Identifier | File or case reference | |||||
prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||
originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||
payee | 0..1 | BackboneElement | Recipient of benefits payable | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
party | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
referral | 0..1 | Reference(ServiceRequest) | Treatment referral | |||||
facility | 0..1 | Reference(Location) | Servicing facility | |||||
careTeam | S | 1..* | BackboneElement | Members of the care team | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | S | 1..1 | positiveInt | Order of care team | ||||
provider | S | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
identifier | SΣ | 1..1 | Identifier | Logical reference, when literal reference is not known | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
system | SΣ | 1..1 | uri | The namespace for the identifier value Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi | ||||
value | SΣ | 1..1 | string | The value that is unique Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
display | Σ | 0..1 | string | Text alternative for the resource | ||||
responsible | 0..1 | boolean | Indicator of the lead practitioner | |||||
role | S | 1..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
qualification | S | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: BeVSCdHcParty (required) | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
supportingInfo | S | 0..* | BackboneElement | Supporting information | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |||||
code | S | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | ||||
timing[x] | 0..1 | When it occurred | ||||||
timingDate | date | |||||||
timingPeriod | Period | |||||||
Slices for value[x] | 0..1 | Data to be provided Slice: Unordered, Open by type:$this | ||||||
valueBoolean | boolean | |||||||
valueString | string | |||||||
valueQuantity | Quantity | |||||||
valueAttachment | Attachment | |||||||
valueReference | Reference(Resource) | |||||||
value[x]:valueReference | S | 0..1 | Reference(Resource) | Data to be provided | ||||
reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
diagnosis | 0..* | BackboneElement | Pertinent diagnosis information | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Diagnosis instance identifier | |||||
diagnosis[x] | 1..1 | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||||||
diagnosisCodeableConcept | CodeableConcept | |||||||
diagnosisReference | Reference(Condition) | |||||||
type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. | |||||
onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||
packageCode | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||
procedure | 0..* | BackboneElement | Clinical procedures performed | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Procedure instance identifier | |||||
type | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||
date | 0..1 | dateTime | When the procedure was performed | |||||
procedure[x] | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||||||
procedureCodeableConcept | CodeableConcept | |||||||
procedureReference | Reference(Procedure) | |||||||
udi | 0..* | Reference(Device) | Unique device identifier | |||||
insurance | Σ | 1..* | BackboneElement | Patient insurance information | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier Required Pattern: 1 | ||||
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | ||||
identifier | 0..1 | Identifier | Pre-assigned Claim number | |||||
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
display | Σ | 0..1 | string | Text alternative for the resource Required Pattern: use of mandatory insurance coverage, no further details provided here. | ||||
businessArrangement | 0..1 | string | Additional provider contract number | |||||
preAuthRef | 0..* | string | Prior authorization reference number | |||||
claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||
accident | 0..1 | BackboneElement | Details of the event | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
date | 1..1 | date | When the incident occurred | |||||
type | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |||||
location[x] | 0..1 | Where the event occurred | ||||||
locationAddress | Address | |||||||
locationReference | Reference(Location) | |||||||
item | S | 1..* | BackboneElement | Product or service provided | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | S | 1..1 | positiveInt | Item instance identifier | ||||
careTeamSequence | S | 1..* | positiveInt | Applicable careTeam members | ||||
diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | |||||
procedureSequence | 0..* | positiveInt | Applicable procedures | |||||
informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information | ||||
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 1..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
Slices for serviced[x] | 1..1 | date | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |||||
serviced[x]:servicedDate | S | 1..1 | date | Date or dates of service or product delivery | ||||
location[x] | 0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
locationCodeableConcept | CodeableConcept | |||||||
locationAddress | Address | |||||||
locationReference | Reference(Location) | |||||||
quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
factor | 0..1 | decimal | Price scaling factor | |||||
net | 0..1 | Money | Total item cost | |||||
udi | 0..* | Reference(Device) | Unique device identifier | |||||
bodySite | S | 0..1 | CodeableConcept | Anatomical location Binding: Body Site (required) | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | SΣ | 0..1 | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | SΣ | 1..1 | uri | Identity of the terminology system | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | SΣ | 1..1 | code | Symbol in syntax defined by the system | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||
detail | 0..* | BackboneElement | Product or service provided | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Item instance identifier | |||||
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
factor | 0..1 | decimal | Price scaling factor | |||||
net | 0..1 | Money | Total item cost | |||||
udi | 0..* | Reference(Device) | Unique device identifier | |||||
subDetail | 0..* | BackboneElement | Product or service provided | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Item instance identifier | |||||
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
factor | 0..1 | decimal | Price scaling factor | |||||
net | 0..1 | Money | Total item cost | |||||
udi | 0..* | Reference(Device) | Unique device identifier | |||||
Documentation for this format |
Path | Conformance | ValueSet / Code | URI | |||
Claim.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
Claim.status | required | Pattern: activehttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | ||||
Claim.subType | extensible | BeVSEtariffTypes (a valid code from eTariff types)https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG | ||||
Claim.use | required | Pattern: predeterminationhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | ||||
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard | ||||
Claim.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard | ||||
Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationship from the FHIR Standard | ||||
Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard | ||||
Claim.careTeam.provider.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard | ||||
Claim.careTeam.provider.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard | ||||
Claim.careTeam.provider.identifier.type | extensible | Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard | ||||
Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole from the FHIR Standard | ||||
Claim.careTeam.qualification | required | BeVSCdHcPartyhttps://www.ehealth.fgov.be/standards/fhir/core/ValueSet/be-vs-cd-hcparty | ||||
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory from the FHIR Standard | ||||
Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception from the FHIR Standard | ||||
Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reason from the FHIR Standard | ||||
Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard | ||||
Claim.diagnosis.type | example | ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype from the FHIR Standard | ||||
Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission from the FHIR Standard | ||||
Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup from the FHIR Standard | ||||
Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type from the FHIR Standard | ||||
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures from the FHIR Standard | ||||
Claim.insurance.coverage.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard | ||||
Claim.accident.type | extensible | ActIncidentCodehttp://terminology.hl7.org/ValueSet/v3-ActIncidentCode | ||||
Claim.item.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
Claim.item.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-place from the FHIR Standard | ||||
Claim.item.bodySite | required | BeVSBodySitehttps://www.ehealth.fgov.be/standards/fhir/core-clinical/ValueSet/be-vs-bodysite | ||||
Claim.item.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surface from the FHIR Standard | ||||
Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
be-inv-gmf-holder | error | Claim | GMF holder CAN only occur in a GP's attestation : Claim.subType.coding.where(code = 'generalpractice').empty() implies Claim.careTeam.where(role.coding.code = 'other').where(qualification.coding.code = 'persphysician').empty() | |
be-inv-related | error | Claim | A related/relative service SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies Claim.supportingInfo.code.coding.where(system = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/NamingSystem/be-ns-claim-related-claim').empty() | |
be-inv-toothnumber | error | Claim | A toothnumber SHALL NOT occur in general practice : Claim.subType.coding.code = 'generalpractice' implies (Claim.item.bodySite.empty() or Claim.item.bodySite.coding.memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-toothnumber-bodysite').not()) | |
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Claim
Summary
Mandatory: 30 elements(2 nested mandatory elements)
Must-Support: 47 elements
Prohibited: 1 element
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Other representations of profile: CSV, Excel, Schematron