SIL HIE Implementation Guide
0.1.0 - sil-hie-active

SIL HIE Implementation Guide, published by Kathurima Kimathi. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/savannahghi/hie-fhir-ig-profile/ and changes regularly. See the Directory of published versions

Resource Profile: HIE Claim

Official URL: https://nshr.dha.go.ke/fhir/StructureDefinition/hie-claim Version: 0.1.0
Active as of 2025-11-25 Computable Name: HIEClaim

R4B Claim constrained for HIE submission and exchange. Emphasizes core administrative data, patient, provider, insurer, billable period, coverage, diagnosis, items, and totals.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..* Identifier Business Identifier for claim
.... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type Σ 1..1 HIECodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 1..1 string The value that is unique
Example General: 123456
.... assigner SΣ 0..1 HIEReference(HIE Organization) Organization that issued id (may be just text)
... type SΣ 1..1 HIECodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType 0..1 HIECodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 HIEReference(HIE Patient) The recipient of the products and services
... billablePeriod Σ 1..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 HIEReference(HIE Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 HIEReference(HIE Organization) Target
... provider SΣ 1..1 HIEReference(HIE Organization | HIE Practitioner | PractitionerRole) Party responsible for the claim
... priority SΣ 1..1 HIECodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 HIECodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... prescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... referral 0..1 HIEReference(ServiceRequest) Treatment referral
... facility 0..1 HIEReference(Location) Servicing facility
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept 0..1 HIECodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosis[x]:diagnosisReference 0..1 HIEReference(Condition) Nature of illness or problem
.... type 0..* HIECodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 HIECodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 HIECodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... insurance SΣ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 HIEReference(Coverage) Insurance information
.... claimResponse 0..1 HIEReference(ClaimResponse) Adjudication results
... item S 1..* BackboneElement Product or service provided
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... revenue 0..1 HIECodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 HIECodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService S 1..1 HIECodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... modifier 0..* HIECodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* HIECodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... udi 0..* HIEReference(Device) Unique device identifier
.... bodySite 0..1 HIECodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* HIECodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 1..1 HIEReference(HIE Encounter) Encounters related to this billed item
... total S 1..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.identifier.use Base required IdentifierUse 📦4.3.0 FHIR Std.
Claim.identifier.type Base extensible IdentifierType 📦4.3.0 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.3.0 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.3.0 FHIR Std.
Claim.subType Base example Example Claim SubType Codes 📍4.3.0 FHIR Std.
Claim.use Base required Use 📍4.3.0 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.3.0 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.3.0 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept Base example ICD-10 Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.3.0 FHIR Std.
Claim.item.revenue Base example Example Revenue Center Codes 📍4.3.0 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.3.0 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.3.0 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.3.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... identifier S 1..* Identifier Business Identifier for claim
.... use 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type 1..1 HIECodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible)
.... system 1..1 uri The namespace for the identifier value
.... value S 1..1 string The value that is unique
.... assigner S 0..1 HIEReference(HIE Organization) Organization that issued id (may be just text)
... status S 1..1 code active | cancelled | draft | entered-in-error
... type S 1..1 HIECodeableConcept Category or discipline
... subType 0..1 HIECodeableConcept More granular claim type
... use S 1..1 code claim | preauthorization | predetermination
... patient S 1..1 HIEReference(HIE Patient) The recipient of the products and services
... billablePeriod 1..1 Period Relevant time frame for the claim
... created S 1..1 dateTime Resource creation date
... enterer 0..1 HIEReference(HIE Practitioner | PractitionerRole) Author of the claim
... insurer 0..1 HIEReference(HIE Organization) Target
... provider S 1..1 HIEReference(HIE Organization | HIE Practitioner | PractitionerRole) Party responsible for the claim
... priority S 1..1 HIECodeableConcept Desired processing ugency
... fundsReserve 0..1 HIECodeableConcept For whom to reserve funds
... related
.... claim 0..1 HIEReference(HIE Claim) Reference to the related claim
... prescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee
.... type 1..1 HIECodeableConcept Category of recipient
.... party 1..1 HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient | RelatedPerson) Recipient reference
... referral 0..1 HIEReference(ServiceRequest) Treatment referral
... facility 0..1 HIEReference(Location) Servicing facility
... careTeam
.... provider 1..1 HIEReference(HIE Practitioner | PractitionerRole | HIE Organization) Practitioner or organization
.... role 0..1 HIECodeableConcept Function within the team
.... qualification 0..1 HIECodeableConcept Practitioner credential or specialization
... supportingInfo
.... category 1..1 HIECodeableConcept Classification of the supplied information
.... code 0..1 HIECodeableConcept Type of information
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Open by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueReference 0..1 HIEReference(Resource) Data to be provided
.... reason 0..1 HIECodeableConcept Explanation for the information
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Open by type:$this
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept 0..1 HIECodeableConcept Nature of illness or problem
..... diagnosis[x]:diagnosisReference 0..1 HIEReference(Condition) Nature of illness or problem
.... type 0..* HIECodeableConcept Timing or nature of the diagnosis
.... onAdmission 0..1 HIECodeableConcept Present on admission
.... packageCode 0..1 HIECodeableConcept Package billing code
... procedure
.... type 0..* HIECodeableConcept Category of Procedure
.... Slices for procedure[x] 1..1 Specific clinical procedure
Slice: Unordered, Open by type:$this
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
..... procedure[x]:procedureCodeableConcept 0..1 HIECodeableConcept Specific clinical procedure
..... procedure[x]:procedureReference 0..1 HIEReference(Procedure) Specific clinical procedure
.... udi 0..* HIEReference(Device) Unique device identifier
... insurance S 1..* BackboneElement Patient insurance information
.... coverage 1..1 HIEReference(Coverage) Insurance information
.... claimResponse 0..1 HIEReference(ClaimResponse) Adjudication results
... accident
.... type 0..1 HIECodeableConcept The nature of the accident
... item S 1..* BackboneElement Product or service provided
.... revenue 0..1 HIECodeableConcept Revenue or cost center code
.... category 0..1 HIECodeableConcept Benefit classification
.... productOrService S 1..1 HIECodeableConcept Billing, service, product, or drug code
.... modifier 0..* HIECodeableConcept Product or service billing modifiers
.... programCode 0..* HIECodeableConcept Program the product or service is provided under
.... udi 0..* HIEReference(Device) Unique device identifier
.... bodySite 0..1 HIECodeableConcept Anatomical location
.... subSite 0..* HIECodeableConcept Anatomical sub-location
.... encounter 1..1 HIEReference(HIE Encounter) Encounters related to this billed item
.... detail
..... revenue 0..1 HIECodeableConcept Revenue or cost center code
..... category 0..1 HIECodeableConcept Benefit classification
..... productOrService 1..1 HIECodeableConcept Billing, service, product, or drug code
..... modifier 0..* HIECodeableConcept Service/Product billing modifiers
..... udi 0..* HIEReference(Device) Unique device identifier
..... subDetail
...... revenue 0..1 HIECodeableConcept Revenue or cost center code
...... category 0..1 HIECodeableConcept Benefit classification
...... productOrService 1..1 HIECodeableConcept Billing, service, product, or drug code
...... modifier 0..* HIECodeableConcept Service/Product billing modifiers
...... programCode 0..* HIECodeableConcept Program the product or service is provided under
...... udi 0..* HIEReference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.identifier.use Base required IdentifierUse 📦4.3.0 FHIR Std.
Claim.identifier.type Base extensible IdentifierType 📦4.3.0 FHIR Std.
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): IETF language tag
Additional BindingsPurpose
AllLanguages Max Binding
... 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
... contained 0..* Resource Contained, inline Resources
Constraints: dom-r4b
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..* Identifier Business Identifier for claim
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type Σ 1..1 HIECodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 1..1 string The value that is unique
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner SΣ 0..1 HIEReference(HIE Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 HIECodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType 0..1 HIECodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 HIEReference(HIE Patient) The recipient of the products and services
... billablePeriod Σ 1..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 HIEReference(HIE Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 HIEReference(HIE Organization) Target
... provider SΣ 1..1 HIEReference(HIE Organization | HIE Practitioner | PractitionerRole) Party responsible for the claim
... priority SΣ 1..1 HIECodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 HIECodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 HIEReference(HIE Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 HIECodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
.... party 1..1 HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient | RelatedPerson) Recipient reference
... referral 0..1 HIEReference(ServiceRequest) Treatment referral
... facility 0..1 HIEReference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 HIEReference(HIE Practitioner | PractitionerRole | HIE Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 HIECodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... qualification 0..1 HIECodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 HIECodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 HIECodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Open by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueReference 0..1 HIEReference(Resource) Data to be provided
.... reason 0..1 HIECodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept 0..1 HIECodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosis[x]:diagnosisReference 0..1 HIEReference(Condition) Nature of illness or problem
.... type 0..* HIECodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 HIECodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 HIECodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* HIECodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... Slices for procedure[x] 1..1 Specific clinical procedure
Slice: Unordered, Closed by type:$this
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
..... procedure[x]:procedureCodeableConcept 0..1 HIECodeableConcept Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedure[x]:procedureReference 0..1 HIEReference(Procedure) Specific clinical procedure
.... udi 0..* HIEReference(Device) Unique device identifier
... insurance SΣ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 HIEReference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 HIEReference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 HIECodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 1..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 HIECodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 HIECodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService S 1..1 HIECodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... modifier 0..* HIECodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* HIECodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.3.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* HIEReference(Device) Unique device identifier
.... bodySite 0..1 HIECodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* HIECodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 1..1 HIEReference(HIE Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 HIECodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 HIECodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 HIECodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* HIECodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 0..1 SimpleQuantity(4.3.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* HIEReference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 HIECodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 HIECodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 HIECodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* HIECodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* HIECodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 0..1 SimpleQuantity(4.3.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* HIEReference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.3.0 FHIR Std.
Claim.identifier.use Base required IdentifierUse 📦4.3.0 FHIR Std.
Claim.identifier.type Base extensible IdentifierType 📦4.3.0 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.3.0 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.3.0 FHIR Std.
Claim.subType Base example Example Claim SubType Codes 📍4.3.0 FHIR Std.
Claim.use Base required Use 📍4.3.0 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.3.0 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.3.0 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.3.0 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.3.0 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.3.0 FHIR Std.
Claim.careTeam.qualification Base example Example Provider Qualification Codes 📍4.3.0 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.3.0 FHIR Std.
Claim.supportingInfo.​code Base example Exception Codes 📍4.3.0 FHIR Std.
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept Base example ICD-10 Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.3.0 FHIR Std.
Claim.procedure.type Base example Example Procedure Type Codes 📍4.3.0 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.3.0 FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept Base example ICD-10 Procedure Codes 📍4.3.0 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
Claim.item.revenue Base example Example Revenue Center Codes 📍4.3.0 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.3.0 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍4.3.0 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.3.0 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.3.0 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.3.0 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍4.3.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where(((id.exists() and ('#'+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(uri) = '#').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()
dom-r4b warning Claim.contained Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

Summary

Mandatory: 10 elements(1 nested mandatory element)
Must-Support: 15 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
  • The element 1 is sliced based on the value of Claim.diagnosis.diagnosis[x]
  • The element 1 is sliced based on the value of Claim.procedure.procedure[x]

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..* Identifier Business Identifier for claim
.... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type Σ 1..1 HIECodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 1..1 string The value that is unique
Example General: 123456
.... assigner SΣ 0..1 HIEReference(HIE Organization) Organization that issued id (may be just text)
... type SΣ 1..1 HIECodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType 0..1 HIECodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 HIEReference(HIE Patient) The recipient of the products and services
... billablePeriod Σ 1..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 HIEReference(HIE Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 HIEReference(HIE Organization) Target
... provider SΣ 1..1 HIEReference(HIE Organization | HIE Practitioner | PractitionerRole) Party responsible for the claim
... priority SΣ 1..1 HIECodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 HIECodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... prescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... referral 0..1 HIEReference(ServiceRequest) Treatment referral
... facility 0..1 HIEReference(Location) Servicing facility
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept 0..1 HIECodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosis[x]:diagnosisReference 0..1 HIEReference(Condition) Nature of illness or problem
.... type 0..* HIECodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 HIECodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 HIECodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... insurance SΣ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 HIEReference(Coverage) Insurance information
.... claimResponse 0..1 HIEReference(ClaimResponse) Adjudication results
... item S 1..* BackboneElement Product or service provided
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... revenue 0..1 HIECodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 HIECodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService S 1..1 HIECodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... modifier 0..* HIECodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* HIECodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... udi 0..* HIEReference(Device) Unique device identifier
.... bodySite 0..1 HIECodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* HIECodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 1..1 HIEReference(HIE Encounter) Encounters related to this billed item
... total S 1..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.identifier.use Base required IdentifierUse 📦4.3.0 FHIR Std.
Claim.identifier.type Base extensible IdentifierType 📦4.3.0 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.3.0 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.3.0 FHIR Std.
Claim.subType Base example Example Claim SubType Codes 📍4.3.0 FHIR Std.
Claim.use Base required Use 📍4.3.0 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.3.0 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.3.0 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept Base example ICD-10 Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.3.0 FHIR Std.
Claim.item.revenue Base example Example Revenue Center Codes 📍4.3.0 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.3.0 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.3.0 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.3.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where(((id.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... identifier S 1..* Identifier Business Identifier for claim
.... use 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type 1..1 HIECodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible)
.... system 1..1 uri The namespace for the identifier value
.... value S 1..1 string The value that is unique
.... assigner S 0..1 HIEReference(HIE Organization) Organization that issued id (may be just text)
... status S 1..1 code active | cancelled | draft | entered-in-error
... type S 1..1 HIECodeableConcept Category or discipline
... subType 0..1 HIECodeableConcept More granular claim type
... use S 1..1 code claim | preauthorization | predetermination
... patient S 1..1 HIEReference(HIE Patient) The recipient of the products and services
... billablePeriod 1..1 Period Relevant time frame for the claim
... created S 1..1 dateTime Resource creation date
... enterer 0..1 HIEReference(HIE Practitioner | PractitionerRole) Author of the claim
... insurer 0..1 HIEReference(HIE Organization) Target
... provider S 1..1 HIEReference(HIE Organization | HIE Practitioner | PractitionerRole) Party responsible for the claim
... priority S 1..1 HIECodeableConcept Desired processing ugency
... fundsReserve 0..1 HIECodeableConcept For whom to reserve funds
... related
.... claim 0..1 HIEReference(HIE Claim) Reference to the related claim
... prescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee
.... type 1..1 HIECodeableConcept Category of recipient
.... party 1..1 HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient | RelatedPerson) Recipient reference
... referral 0..1 HIEReference(ServiceRequest) Treatment referral
... facility 0..1 HIEReference(Location) Servicing facility
... careTeam
.... provider 1..1 HIEReference(HIE Practitioner | PractitionerRole | HIE Organization) Practitioner or organization
.... role 0..1 HIECodeableConcept Function within the team
.... qualification 0..1 HIECodeableConcept Practitioner credential or specialization
... supportingInfo
.... category 1..1 HIECodeableConcept Classification of the supplied information
.... code 0..1 HIECodeableConcept Type of information
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Open by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueReference 0..1 HIEReference(Resource) Data to be provided
.... reason 0..1 HIECodeableConcept Explanation for the information
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Open by type:$this
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept 0..1 HIECodeableConcept Nature of illness or problem
..... diagnosis[x]:diagnosisReference 0..1 HIEReference(Condition) Nature of illness or problem
.... type 0..* HIECodeableConcept Timing or nature of the diagnosis
.... onAdmission 0..1 HIECodeableConcept Present on admission
.... packageCode 0..1 HIECodeableConcept Package billing code
... procedure
.... type 0..* HIECodeableConcept Category of Procedure
.... Slices for procedure[x] 1..1 Specific clinical procedure
Slice: Unordered, Open by type:$this
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
..... procedure[x]:procedureCodeableConcept 0..1 HIECodeableConcept Specific clinical procedure
..... procedure[x]:procedureReference 0..1 HIEReference(Procedure) Specific clinical procedure
.... udi 0..* HIEReference(Device) Unique device identifier
... insurance S 1..* BackboneElement Patient insurance information
.... coverage 1..1 HIEReference(Coverage) Insurance information
.... claimResponse 0..1 HIEReference(ClaimResponse) Adjudication results
... accident
.... type 0..1 HIECodeableConcept The nature of the accident
... item S 1..* BackboneElement Product or service provided
.... revenue 0..1 HIECodeableConcept Revenue or cost center code
.... category 0..1 HIECodeableConcept Benefit classification
.... productOrService S 1..1 HIECodeableConcept Billing, service, product, or drug code
.... modifier 0..* HIECodeableConcept Product or service billing modifiers
.... programCode 0..* HIECodeableConcept Program the product or service is provided under
.... udi 0..* HIEReference(Device) Unique device identifier
.... bodySite 0..1 HIECodeableConcept Anatomical location
.... subSite 0..* HIECodeableConcept Anatomical sub-location
.... encounter 1..1 HIEReference(HIE Encounter) Encounters related to this billed item
.... detail
..... revenue 0..1 HIECodeableConcept Revenue or cost center code
..... category 0..1 HIECodeableConcept Benefit classification
..... productOrService 1..1 HIECodeableConcept Billing, service, product, or drug code
..... modifier 0..* HIECodeableConcept Service/Product billing modifiers
..... udi 0..* HIEReference(Device) Unique device identifier
..... subDetail
...... revenue 0..1 HIECodeableConcept Revenue or cost center code
...... category 0..1 HIECodeableConcept Benefit classification
...... productOrService 1..1 HIECodeableConcept Billing, service, product, or drug code
...... modifier 0..* HIECodeableConcept Service/Product billing modifiers
...... programCode 0..* HIECodeableConcept Program the product or service is provided under
...... udi 0..* HIEReference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.identifier.use Base required IdentifierUse 📦4.3.0 FHIR Std.
Claim.identifier.type Base extensible IdentifierType 📦4.3.0 FHIR Std.

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): IETF language tag
Additional BindingsPurpose
AllLanguages Max Binding
... 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
... contained 0..* Resource Contained, inline Resources
Constraints: dom-r4b
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..* Identifier Business Identifier for claim
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type Σ 1..1 HIECodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible)
.... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 1..1 string The value that is unique
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner SΣ 0..1 HIEReference(HIE Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 1..1 HIECodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType 0..1 HIECodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
... patient SΣ 1..1 HIEReference(HIE Patient) The recipient of the products and services
... billablePeriod Σ 1..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 HIEReference(HIE Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 HIEReference(HIE Organization) Target
... provider SΣ 1..1 HIEReference(HIE Organization | HIE Practitioner | PractitionerRole) Party responsible for the claim
... priority SΣ 1..1 HIECodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 HIECodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 HIEReference(HIE Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 HIEReference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 HIECodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
.... party 1..1 HIEReference(HIE Practitioner | PractitionerRole | HIE Organization | HIE Patient | RelatedPerson) Recipient reference
... referral 0..1 HIEReference(ServiceRequest) Treatment referral
... facility 0..1 HIEReference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 HIEReference(HIE Practitioner | PractitionerRole | HIE Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 HIECodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... qualification 0..1 HIECodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 HIECodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 HIECodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Open by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueReference 0..1 HIEReference(Resource) Data to be provided
.... reason 0..1 HIECodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 1..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept 0..1 HIECodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosis[x]:diagnosisReference 0..1 HIEReference(Condition) Nature of illness or problem
.... type 0..* HIECodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 HIECodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 HIECodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* HIECodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... Slices for procedure[x] 1..1 Specific clinical procedure
Slice: Unordered, Closed by type:$this
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
..... procedure[x]:procedureCodeableConcept 0..1 HIECodeableConcept Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedure[x]:procedureReference 0..1 HIEReference(Procedure) Specific clinical procedure
.... udi 0..* HIEReference(Device) Unique device identifier
... insurance SΣ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 HIEReference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 HIEReference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 HIECodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 1..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 HIECodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 HIECodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService S 1..1 HIECodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... modifier 0..* HIECodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* HIECodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.3.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* HIEReference(Device) Unique device identifier
.... bodySite 0..1 HIECodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* HIECodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 1..1 HIEReference(HIE Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 HIECodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 HIECodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 HIECodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* HIECodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 0..1 SimpleQuantity(4.3.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* HIEReference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 HIECodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 HIECodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 HIECodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* HIECodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* HIECodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 0..1 SimpleQuantity(4.3.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* HIEReference(Device) Unique device identifier
... total S 1..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.3.0 FHIR Std.
Claim.identifier.use Base required IdentifierUse 📦4.3.0 FHIR Std.
Claim.identifier.type Base extensible IdentifierType 📦4.3.0 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.3.0 FHIR Std.
Claim.type Base extensible Claim Type Codes 📍4.3.0 FHIR Std.
Claim.subType Base example Example Claim SubType Codes 📍4.3.0 FHIR Std.
Claim.use Base required Use 📍4.3.0 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.3.0 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.3.0 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.3.0 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.3.0 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.3.0 FHIR Std.
Claim.careTeam.qualification Base example Example Provider Qualification Codes 📍4.3.0 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.3.0 FHIR Std.
Claim.supportingInfo.​code Base example Exception Codes 📍4.3.0 FHIR Std.
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept Base example ICD-10 Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.3.0 FHIR Std.
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.3.0 FHIR Std.
Claim.procedure.type Base example Example Procedure Type Codes 📍4.3.0 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.3.0 FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept Base example ICD-10 Procedure Codes 📍4.3.0 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
Claim.item.revenue Base example Example Revenue Center Codes 📍4.3.0 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.3.0 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍4.3.0 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.3.0 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.3.0 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.3.0 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.3.0 FHIR Std.
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍4.3.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where(((id.exists() and ('#'+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(uri) = '#').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()
dom-r4b warning Claim.contained Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

Summary

Mandatory: 10 elements(1 nested mandatory element)
Must-Support: 15 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
  • The element 1 is sliced based on the value of Claim.diagnosis.diagnosis[x]
  • The element 1 is sliced based on the value of Claim.procedure.procedure[x]

 

Other representations of profile: CSV, Excel, Schematron