Belgian MyCareNet Profiles, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 2.2.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/mycarenet/ and changes regularly. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• XML
• JSON

Resource Profile: MyCareNet eAgreement Claim BE profile

Usages:

• Derived from this Profile: MyCareNet eAgreement Claim Kine BE profile and MyCareNet eAgreement Claim Logo BE profile
• Use this Profile: MyCareNet eAgreement Demand Bundle BE profile

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3
Claim.id	S This element must be supported. Σ This element is included in summaries.	1..1	id	Logical id of this artifact
Claim.meta	S This element must be supported. Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active (no extensions allowed)
Claim.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.type.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.type.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type (no extensions allowed)
Claim.type.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.subType	S This element must be supported.	1..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.subType.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types (extensions allowed)
Claim.subType.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization (no extensions allowed)
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(BePatient)	The recipient of the products and services
Claim.billablePeriod	S This element must be supported. Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.enterer	S This element must be supported.	0..1	Reference(BePractitionerRole)	Author of the claim
Claim.enterer.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
Claim.provider.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.priority	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.priority.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.priority.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority (no extensions allowed)
Claim.priority.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.referral.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.supportingInfo	S This element must be supported.	0..*	BackboneElement	Supporting information
Claim.supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.category.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.category.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.supportingInfo.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.insurance	S This element must be supported. Σ This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier Fixed Value: 1 (no extensions allowed)
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.coverage.display	Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Claim.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrService.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Binding: ValueSet product or service (extensible)
Claim.item.productOrService.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.item.productOrService.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.item.serviced[x]		0..1	date	Date or dates of service or product delivery
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService.​coding	Base	extensible	ValueSet product or service	📦2.2.1	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
be-rule-eagreementclaim-1	error	Claim	Billable period start and end SHALL be YYYY-MM-DD	(Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10)
be-rule-eagreementclaim-2	error	Claim	Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz	Claim.created.toString().length()=25
be-rule-eagreementclaim-3	error	Claim	Procedure.date SHALL be YYYY-MM-DD	Claim.procedure.date.exists() implies Claim.procedure.date.select(toString().length()=10).allTrue()
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3
Claim.id	S This element must be supported.	1..1	id	Logical id of this artifact
Claim.meta	S This element must be supported.	1..1	Meta	Metadata about the resource
Claim.meta.profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error Fixed Value: active (no extensions allowed)
Claim.type	S This element must be supported.	1..1	CodeableConcept	Category or discipline
Claim.type.coding		1..1	Coding	Code defined by a terminology system
Claim.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type (no extensions allowed)
Claim.type.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.subType	S This element must be supported.	1..1	CodeableConcept	More granular claim type
Claim.subType.coding		1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system		1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types (extensions allowed)
Claim.subType.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.use	S This element must be supported.	1..1	code	claim | preauthorization | predetermination Fixed Value: preauthorization (no extensions allowed)
Claim.patient	S This element must be supported.	1..1	Reference(BePatient)	The recipient of the products and services
Claim.billablePeriod	S This element must be supported.	0..1	Period	Relevant time frame for the claim
Claim.created	S This element must be supported.	1..1	dateTime	Resource creation date
Claim.enterer	S This element must be supported.	0..1	Reference(BePractitionerRole)	Author of the claim
Claim.enterer.reference		1..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider	S This element must be supported.	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
Claim.provider.reference		1..1	string	Literal reference, Relative, internal or absolute URL
Claim.priority	S This element must be supported.	1..1	CodeableConcept	Desired processing ugency
Claim.priority.coding		1..1	Coding	Code defined by a terminology system
Claim.priority.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority (no extensions allowed)
Claim.priority.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.referral.reference		1..1	string	Literal reference, Relative, internal or absolute URL
Claim.supportingInfo	S This element must be supported.	0..*	BackboneElement	Supporting information
Claim.supportingInfo.category	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information
Claim.supportingInfo.category.coding		1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.category.coding.system		1..1	uri	Identity of the terminology system
Claim.supportingInfo.category.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.supportingInfo.code
Claim.supportingInfo.code.coding		1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.code.coding.system		1..1	uri	Identity of the terminology system
Claim.supportingInfo.code.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.insurance	S This element must be supported.	1..1	BackboneElement	Patient insurance information
Claim.insurance.sequence		1..1	positiveInt	Insurance instance identifier Fixed Value: 1 (no extensions allowed)
Claim.insurance.focal		1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.coverage
Claim.insurance.coverage.display		1..1	string	Text alternative for the resource
Claim.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
Claim.item.productOrService
Claim.item.productOrService.coding		1..1	Coding	Code defined by a terminology system Binding: ValueSet product or service (extensible)
Claim.item.productOrService.coding.system		1..1	uri	Identity of the terminology system
Claim.item.productOrService.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.item.serviced[x]		0..1	date	Date or dates of service or product delivery
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.item.productOrService.​coding	Base	extensible	ValueSet product or service	📦2.2.1	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
be-rule-eagreementclaim-1	error	Claim	Billable period start and end SHALL be YYYY-MM-DD	(Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10)
be-rule-eagreementclaim-2	error	Claim	Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz	Claim.created.toString().length()=25
be-rule-eagreementclaim-3	error	Claim	Procedure.date SHALL be YYYY-MM-DD	Claim.procedure.date.exists() implies Claim.procedure.date.select(toString().length()=10).allTrue()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3
Claim.id	S This element must be supported. Σ This element is included in summaries.	1..1	id	Logical id of this artifact
Claim.meta	S This element must be supported. Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.id		0..1	string	Unique id for inter-element referencing
Claim.meta.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
Claim.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
Claim.meta.source	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from
Claim.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Claim.meta.tag	Σ This element is included in summaries.	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Claim.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.contained		0..*	Resource	Contained, inline Resources
Claim.extension		0..*	Extension	Additional content defined by implementations
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier		0..*	Identifier	Business Identifier for claim
Claim.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active (no extensions allowed)
Claim.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.type.id		0..1	string	Unique id for inter-element referencing
Claim.type.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.type.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.type.coding.id		0..1	string	Unique id for inter-element referencing
Claim.type.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.type.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type (no extensions allowed)
Claim.type.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.type.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.type.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.type.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.type.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.subType	S This element must be supported.	1..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.subType.id		0..1	string	Unique id for inter-element referencing
Claim.subType.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.subType.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.id		0..1	string	Unique id for inter-element referencing
Claim.subType.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.subType.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types (extensions allowed)
Claim.subType.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.subType.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.subType.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.subType.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.subType.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization (no extensions allowed)
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(BePatient)	The recipient of the products and services
Claim.billablePeriod	S This element must be supported. Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.enterer	S This element must be supported.	0..1	Reference(BePractitionerRole)	Author of the claim
Claim.enterer.id		0..1	string	Unique id for inter-element referencing
Claim.enterer.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.enterer.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.enterer.type	Σ This element is included in summaries.	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).
Claim.enterer.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.enterer.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.insurer	Σ This element is included in summaries.	0..1	Reference(Organization)	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
Claim.provider.id		0..1	string	Unique id for inter-element referencing
Claim.provider.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.provider.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider.type	Σ This element is included in summaries.	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).
Claim.provider.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.provider.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.priority	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.priority.id		0..1	string	Unique id for inter-element referencing
Claim.priority.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.priority.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.priority.coding.id		0..1	string	Unique id for inter-element referencing
Claim.priority.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.priority.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority (no extensions allowed)
Claim.priority.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.priority.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.priority.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.priority.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.priority.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related		0..*	BackboneElement	Prior or corollary claims
Claim.related.id		0..1	string	Unique id for inter-element referencing
Claim.related.extension		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim		0..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference		0..1	Identifier	File or case reference
Claim.prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
Claim.originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
Claim.payee		0..1	BackboneElement	Recipient of benefits payable
Claim.payee.id		0..1	string	Unique id for inter-element referencing
Claim.payee.extension		0..*	Extension	Additional content defined by implementations
Claim.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.payee.type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.payee.party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.referral.id		0..1	string	Unique id for inter-element referencing
Claim.referral.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.referral.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.referral.type	Σ This element is included in summaries.	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).
Claim.referral.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.referral.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.facility		0..1	Reference(Location)	Servicing facility
Claim.careTeam		0..*	BackboneElement	Members of the care team
Claim.careTeam.id		0..1	string	Unique id for inter-element referencing
Claim.careTeam.extension		0..*	Extension	Additional content defined by implementations
Claim.careTeam.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.careTeam.sequence		1..1	positiveInt	Order of care team
Claim.careTeam.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
Claim.careTeam.responsible		0..1	boolean	Indicator of the lead practitioner
Claim.careTeam.role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.careTeam.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.supportingInfo	S This element must be supported.	0..*	BackboneElement	Supporting information
Claim.supportingInfo.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.extension		0..*	Extension	Additional content defined by implementations
Claim.supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.category.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.supportingInfo.category.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.supportingInfo.category.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.supportingInfo.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.supportingInfo.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.supportingInfo.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.supportingInfo.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.supportingInfo.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.supportingInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.supportingInfo.code.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.code.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.supportingInfo.code.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.code.coding.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.code.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.supportingInfo.code.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.supportingInfo.code.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.supportingInfo.code.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.supportingInfo.code.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.supportingInfo.code.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.supportingInfo.code.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.supportingInfo.timing[x]		0..1		When it occurred
Claim.supportingInfo.timing[x].timingDate			date
Claim.supportingInfo.timing[x].timingPeriod			Period
Claim.supportingInfo.value[x]		0..1		Data to be provided
Claim.supportingInfo.value[x].valueBoolean			boolean
Claim.supportingInfo.value[x].valueString			string
Claim.supportingInfo.value[x].valueQuantity			Quantity
Claim.supportingInfo.value[x].valueAttachment			Attachment
Claim.supportingInfo.value[x].valueReference			Reference(Resource)
Claim.supportingInfo.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis		0..*	BackboneElement	Pertinent diagnosis information
Claim.diagnosis.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.extension		0..*	Extension	Additional content defined by implementations
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept			CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference			Reference(Condition)
Claim.diagnosis.type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
Claim.diagnosis.packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Claim.procedure		0..*	BackboneElement	Clinical procedures performed
Claim.procedure.id		0..1	string	Unique id for inter-element referencing
Claim.procedure.extension		0..*	Extension	Additional content defined by implementations
Claim.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier
Claim.procedure.type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
Claim.procedure.date		0..1	dateTime	When the procedure was performed
Claim.procedure.procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept			CodeableConcept
Claim.procedure.procedure[x].procedureReference			Reference(Procedure)
Claim.procedure.udi		0..*	Reference(Device)	Unique device identifier
Claim.insurance	S This element must be supported. Σ This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.id		0..1	string	Unique id for inter-element referencing
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier Fixed Value: 1 (no extensions allowed)
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.coverage.id		0..1	string	Unique id for inter-element referencing
Claim.insurance.coverage.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.insurance.coverage.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Claim.insurance.coverage.type	Σ This element is included in summaries.	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).
Claim.insurance.coverage.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.insurance.coverage.display	Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident		0..1	BackboneElement	Details of the event
Claim.accident.id		0..1	string	Unique id for inter-element referencing
Claim.accident.extension		0..*	Extension	Additional content defined by implementations
Claim.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.accident.date		1..1	date	When the incident occurred
Claim.accident.type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x]		0..1		Where the event occurred
Claim.accident.location[x].locationAddress			Address
Claim.accident.location[x].locationReference			Reference(Location)
Claim.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
Claim.item.id		0..1	string	Unique id for inter-element referencing
Claim.item.extension		0..*	Extension	Additional content defined by implementations
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.careTeamSequence		0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information
Claim.item.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrService.id		0..1	string	Unique id for inter-element referencing
Claim.item.productOrService.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.item.productOrService.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Binding: ValueSet product or service (extensible)
Claim.item.productOrService.coding.id		0..1	string	Unique id for inter-element referencing
Claim.item.productOrService.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.item.productOrService.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.item.productOrService.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.item.productOrService.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.item.productOrService.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.item.productOrService.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.item.modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.serviced[x]		0..1	date	Date or dates of service or product delivery
Claim.item.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConcept			CodeableConcept
Claim.item.location[x].locationAddress			Address
Claim.item.location[x].locationReference			Reference(Location)
Claim.item.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor
Claim.item.net		0..1	Money	Total item cost
Claim.item.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail		0..*	BackboneElement	Product or service provided
Claim.item.detail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		0..1	Money	Total item cost
Claim.item.detail.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.enterer.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.provider.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.referral.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.insurance.coverage.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v7.5
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService.​coding	Base	extensible	ValueSet product or service	📦2.2.1	This IG
Claim.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
be-rule-eagreementclaim-1	error	Claim	Billable period start and end SHALL be YYYY-MM-DD	(Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10)
be-rule-eagreementclaim-2	error	Claim	Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz	Claim.created.toString().length()=25
be-rule-eagreementclaim-3	error	Claim	Procedure.date SHALL be YYYY-MM-DD	Claim.procedure.date.exists() implies Claim.procedure.date.select(toString().length()=10).allTrue()
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
sqty-1	error	Claim.item.quantity, Claim.item.detail.quantity, Claim.item.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from Claim

Summary

Mandatory: 15 elements(11 nested mandatory elements)
Must-Support: 17 elements
Fixed: 6 elements

Structures

This structure refers to these other structures:

• BePatient (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient)
• BePractitionerRole (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole)
• BeOrganization (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization)

Maturity: 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3
Claim.id	S This element must be supported. Σ This element is included in summaries.	1..1	id	Logical id of this artifact
Claim.meta	S This element must be supported. Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active (no extensions allowed)
Claim.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.type.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.type.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type (no extensions allowed)
Claim.type.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.subType	S This element must be supported.	1..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.subType.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types (extensions allowed)
Claim.subType.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization (no extensions allowed)
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(BePatient)	The recipient of the products and services
Claim.billablePeriod	S This element must be supported. Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.enterer	S This element must be supported.	0..1	Reference(BePractitionerRole)	Author of the claim
Claim.enterer.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
Claim.provider.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.priority	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.priority.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.priority.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority (no extensions allowed)
Claim.priority.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.referral.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.supportingInfo	S This element must be supported.	0..*	BackboneElement	Supporting information
Claim.supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.category.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.category.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.supportingInfo.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.insurance	S This element must be supported. Σ This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier Fixed Value: 1 (no extensions allowed)
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.coverage.display	Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Claim.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrService.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Binding: ValueSet product or service (extensible)
Claim.item.productOrService.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.item.productOrService.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.item.serviced[x]		0..1	date	Date or dates of service or product delivery
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService.​coding	Base	extensible	ValueSet product or service	📦2.2.1	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
be-rule-eagreementclaim-1	error	Claim	Billable period start and end SHALL be YYYY-MM-DD	(Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10)
be-rule-eagreementclaim-2	error	Claim	Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz	Claim.created.toString().length()=25
be-rule-eagreementclaim-3	error	Claim	Procedure.date SHALL be YYYY-MM-DD	Claim.procedure.date.exists() implies Claim.procedure.date.select(toString().length()=10).allTrue()
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3
Claim.id	S This element must be supported.	1..1	id	Logical id of this artifact
Claim.meta	S This element must be supported.	1..1	Meta	Metadata about the resource
Claim.meta.profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error Fixed Value: active (no extensions allowed)
Claim.type	S This element must be supported.	1..1	CodeableConcept	Category or discipline
Claim.type.coding		1..1	Coding	Code defined by a terminology system
Claim.type.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type (no extensions allowed)
Claim.type.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.subType	S This element must be supported.	1..1	CodeableConcept	More granular claim type
Claim.subType.coding		1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system		1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types (extensions allowed)
Claim.subType.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.use	S This element must be supported.	1..1	code	claim | preauthorization | predetermination Fixed Value: preauthorization (no extensions allowed)
Claim.patient	S This element must be supported.	1..1	Reference(BePatient)	The recipient of the products and services
Claim.billablePeriod	S This element must be supported.	0..1	Period	Relevant time frame for the claim
Claim.created	S This element must be supported.	1..1	dateTime	Resource creation date
Claim.enterer	S This element must be supported.	0..1	Reference(BePractitionerRole)	Author of the claim
Claim.enterer.reference		1..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider	S This element must be supported.	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
Claim.provider.reference		1..1	string	Literal reference, Relative, internal or absolute URL
Claim.priority	S This element must be supported.	1..1	CodeableConcept	Desired processing ugency
Claim.priority.coding		1..1	Coding	Code defined by a terminology system
Claim.priority.coding.system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority (no extensions allowed)
Claim.priority.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.referral.reference		1..1	string	Literal reference, Relative, internal or absolute URL
Claim.supportingInfo	S This element must be supported.	0..*	BackboneElement	Supporting information
Claim.supportingInfo.category	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information
Claim.supportingInfo.category.coding		1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.category.coding.system		1..1	uri	Identity of the terminology system
Claim.supportingInfo.category.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.supportingInfo.code
Claim.supportingInfo.code.coding		1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.code.coding.system		1..1	uri	Identity of the terminology system
Claim.supportingInfo.code.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.insurance	S This element must be supported.	1..1	BackboneElement	Patient insurance information
Claim.insurance.sequence		1..1	positiveInt	Insurance instance identifier Fixed Value: 1 (no extensions allowed)
Claim.insurance.focal		1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.coverage
Claim.insurance.coverage.display		1..1	string	Text alternative for the resource
Claim.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
Claim.item.productOrService
Claim.item.productOrService.coding		1..1	Coding	Code defined by a terminology system Binding: ValueSet product or service (extensible)
Claim.item.productOrService.coding.system		1..1	uri	Identity of the terminology system
Claim.item.productOrService.coding.code		1..1	code	Symbol in syntax defined by the system
Claim.item.serviced[x]		0..1	date	Date or dates of service or product delivery
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.item.productOrService.​coding	Base	extensible	ValueSet product or service	📦2.2.1	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
be-rule-eagreementclaim-1	error	Claim	Billable period start and end SHALL be YYYY-MM-DD	(Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10)
be-rule-eagreementclaim-2	error	Claim	Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz	Claim.created.toString().length()=25
be-rule-eagreementclaim-3	error	Claim	Procedure.date SHALL be YYYY-MM-DD	Claim.procedure.date.exists() implies Claim.procedure.date.select(toString().length()=10).allTrue()

Snapshot ViewView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	Claim	Claim, Pre-determination or Pre-authorization Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3
Claim.id	S This element must be supported. Σ This element is included in summaries.	1..1	id	Logical id of this artifact
Claim.meta	S This element must be supported. Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.id		0..1	string	Unique id for inter-element referencing
Claim.meta.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
Claim.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
Claim.meta.source	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from
Claim.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Claim.meta.tag	Σ This element is included in summaries.	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Claim.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.contained		0..*	Resource	Contained, inline Resources
Claim.extension		0..*	Extension	Additional content defined by implementations
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier		0..*	Identifier	Business Identifier for claim
Claim.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active (no extensions allowed)
Claim.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.type.id		0..1	string	Unique id for inter-element referencing
Claim.type.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.type.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.type.coding.id		0..1	string	Unique id for inter-element referencing
Claim.type.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.type.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type (no extensions allowed)
Claim.type.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.type.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.type.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.type.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.type.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.subType	S This element must be supported.	1..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.subType.id		0..1	string	Unique id for inter-element referencing
Claim.subType.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.subType.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.id		0..1	string	Unique id for inter-element referencing
Claim.subType.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.subType.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types (extensions allowed)
Claim.subType.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.subType.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.subType.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.subType.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.subType.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization (no extensions allowed)
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(BePatient)	The recipient of the products and services
Claim.billablePeriod	S This element must be supported. Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.enterer	S This element must be supported.	0..1	Reference(BePractitionerRole)	Author of the claim
Claim.enterer.id		0..1	string	Unique id for inter-element referencing
Claim.enterer.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.enterer.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.enterer.type	Σ This element is included in summaries.	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).
Claim.enterer.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.enterer.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.insurer	Σ This element is included in summaries.	0..1	Reference(Organization)	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
Claim.provider.id		0..1	string	Unique id for inter-element referencing
Claim.provider.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.provider.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider.type	Σ This element is included in summaries.	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).
Claim.provider.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.provider.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.priority	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.priority.id		0..1	string	Unique id for inter-element referencing
Claim.priority.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.priority.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.priority.coding.id		0..1	string	Unique id for inter-element referencing
Claim.priority.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.priority.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority (no extensions allowed)
Claim.priority.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.priority.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.priority.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.priority.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.priority.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related		0..*	BackboneElement	Prior or corollary claims
Claim.related.id		0..1	string	Unique id for inter-element referencing
Claim.related.extension		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim		0..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference		0..1	Identifier	File or case reference
Claim.prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
Claim.originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
Claim.payee		0..1	BackboneElement	Recipient of benefits payable
Claim.payee.id		0..1	string	Unique id for inter-element referencing
Claim.payee.extension		0..*	Extension	Additional content defined by implementations
Claim.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.payee.type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.payee.party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.referral.id		0..1	string	Unique id for inter-element referencing
Claim.referral.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.referral.reference	Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.referral.type	Σ This element is included in summaries.	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).
Claim.referral.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.referral.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.facility		0..1	Reference(Location)	Servicing facility
Claim.careTeam		0..*	BackboneElement	Members of the care team
Claim.careTeam.id		0..1	string	Unique id for inter-element referencing
Claim.careTeam.extension		0..*	Extension	Additional content defined by implementations
Claim.careTeam.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.careTeam.sequence		1..1	positiveInt	Order of care team
Claim.careTeam.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
Claim.careTeam.responsible		0..1	boolean	Indicator of the lead practitioner
Claim.careTeam.role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.careTeam.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.supportingInfo	S This element must be supported.	0..*	BackboneElement	Supporting information
Claim.supportingInfo.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.extension		0..*	Extension	Additional content defined by implementations
Claim.supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category	S This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.category.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.category.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.supportingInfo.category.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.category.coding.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.category.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.supportingInfo.category.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.supportingInfo.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.supportingInfo.category.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.supportingInfo.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.supportingInfo.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.supportingInfo.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.supportingInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.supportingInfo.code.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.code.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.supportingInfo.code.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.code.coding.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.code.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.supportingInfo.code.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.supportingInfo.code.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.supportingInfo.code.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.supportingInfo.code.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.supportingInfo.code.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.supportingInfo.code.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.supportingInfo.timing[x]		0..1		When it occurred
Claim.supportingInfo.timing[x].timingDate			date
Claim.supportingInfo.timing[x].timingPeriod			Period
Claim.supportingInfo.value[x]		0..1		Data to be provided
Claim.supportingInfo.value[x].valueBoolean			boolean
Claim.supportingInfo.value[x].valueString			string
Claim.supportingInfo.value[x].valueQuantity			Quantity
Claim.supportingInfo.value[x].valueAttachment			Attachment
Claim.supportingInfo.value[x].valueReference			Reference(Resource)
Claim.supportingInfo.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis		0..*	BackboneElement	Pertinent diagnosis information
Claim.diagnosis.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.extension		0..*	Extension	Additional content defined by implementations
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept			CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference			Reference(Condition)
Claim.diagnosis.type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
Claim.diagnosis.packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Claim.procedure		0..*	BackboneElement	Clinical procedures performed
Claim.procedure.id		0..1	string	Unique id for inter-element referencing
Claim.procedure.extension		0..*	Extension	Additional content defined by implementations
Claim.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier
Claim.procedure.type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
Claim.procedure.date		0..1	dateTime	When the procedure was performed
Claim.procedure.procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept			CodeableConcept
Claim.procedure.procedure[x].procedureReference			Reference(Procedure)
Claim.procedure.udi		0..*	Reference(Device)	Unique device identifier
Claim.insurance	S This element must be supported. Σ This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.id		0..1	string	Unique id for inter-element referencing
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier Fixed Value: 1 (no extensions allowed)
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.coverage.id		0..1	string	Unique id for inter-element referencing
Claim.insurance.coverage.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.insurance.coverage.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Claim.insurance.coverage.type	Σ This element is included in summaries.	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).
Claim.insurance.coverage.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Claim.insurance.coverage.display	Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident		0..1	BackboneElement	Details of the event
Claim.accident.id		0..1	string	Unique id for inter-element referencing
Claim.accident.extension		0..*	Extension	Additional content defined by implementations
Claim.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.accident.date		1..1	date	When the incident occurred
Claim.accident.type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x]		0..1		Where the event occurred
Claim.accident.location[x].locationAddress			Address
Claim.accident.location[x].locationReference			Reference(Location)
Claim.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
Claim.item.id		0..1	string	Unique id for inter-element referencing
Claim.item.extension		0..*	Extension	Additional content defined by implementations
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.careTeamSequence		0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information
Claim.item.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrService.id		0..1	string	Unique id for inter-element referencing
Claim.item.productOrService.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.item.productOrService.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system Binding: ValueSet product or service (extensible)
Claim.item.productOrService.coding.id		0..1	string	Unique id for inter-element referencing
Claim.item.productOrService.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.item.productOrService.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.item.productOrService.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.item.productOrService.coding.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.item.productOrService.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.item.productOrService.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.item.modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.serviced[x]		0..1	date	Date or dates of service or product delivery
Claim.item.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConcept			CodeableConcept
Claim.item.location[x].locationAddress			Address
Claim.item.location[x].locationReference			Reference(Location)
Claim.item.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor
Claim.item.net		0..1	Money	Total item cost
Claim.item.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail		0..*	BackboneElement	Product or service provided
Claim.item.detail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		0..1	Money	Total item cost
Claim.item.detail.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.enterer.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.provider.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.referral.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.insurance.coverage.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v7.5
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService.​coding	Base	extensible	ValueSet product or service	📦2.2.1	This IG
Claim.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
be-rule-eagreementclaim-1	error	Claim	Billable period start and end SHALL be YYYY-MM-DD	(Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10)
be-rule-eagreementclaim-2	error	Claim	Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz	Claim.created.toString().length()=25
be-rule-eagreementclaim-3	error	Claim	Procedure.date SHALL be YYYY-MM-DD	Claim.procedure.date.exists() implies Claim.procedure.date.select(toString().length()=10).allTrue()
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
sqty-1	error	Claim.item.quantity, Claim.item.detail.quantity, Claim.item.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from Claim

Summary

Mandatory: 15 elements(11 nested mandatory elements)
Must-Support: 17 elements
Fixed: 6 elements

Structures

This structure refers to these other structures:

• BePatient (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient)
• BePractitionerRole (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole)
• BeOrganization (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization)

Maturity: 1