Uzbekistan Digital Health Platform, published by Ministry of Health of the Republic of Uzbekistan. This guide is not an authorized publication; it is the continuous build for version 0.11.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/uzinfocom-org/digital-health-ig/ and changes regularly. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• Examples
• JSON

Resource Profile: UZ Core Claim ( Experimental )

Usages:

• Refer to this Profile: UZ Core ClaimResponse
• Examples for this Profile: Claim/example-claim

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		0..*	Claim(5.0.0)	Claim, Pre-determination or Pre-authorization
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.contained		0..*	Resource	Contained, inline Resources
Claim.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
Claim.identifier	S This element must be supported.	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	Status of current claim Binding: FMStatusVS (0.11.1) (required)
Claim.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeVS (0.11.1) (required)
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	preauthorization | predetermination | claim Binding: ClaimUseVS (0.11.1) (required)
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(UZ Core Patient(0.11.1))	The recipient of the products and services
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.insurer	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(UZ Core Organization(0.11.1))	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(UZ Core Organization(0.11.1))	Party responsible for the claim
Claim.prescription	S This element must be supported.	0..1	Reference(UZ Core MedicationRequest(0.11.1))	Refers to the reimbursement prescription.
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility	S This element must be supported.	0..1	Reference(UZ Core Location(0.11.1) | UZ Core Organization(0.11.1))	Servicing facility
Claim.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
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 Constraints: ext-1
Claim.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1		Nature of illness or problem Binding: ICD10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept			CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference			Reference(Condition)
Claim.insurance	S This element must be supported. Σ This element is included in summaries.	0..*	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 Constraints: ext-1
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	S This element must be supported. Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.total	S This element must be supported.	0..1	Money	Total claim cost
Claim.total.value	S This element must be supported. Σ This element is included in summaries.	0..1	decimal	Numerical value (with implicit precision)
Claim.total.currency	S This element must be supported. Σ This element is included in summaries.	0..1	code	ISO 4217 currency code Binding: Currencies (required)
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Management Status Value set	📍0.11.1	This IG
Claim.type	Base	required	Claim Type VS	📍0.11.1	This IG
Claim.use	Base	required	Claim Use Value set	📍0.11.1	This IG
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍5.0.0	FHIR Std.
Claim.total.currency	Base	required	Currencies	📍5.0.0	FHIR Std.

Constraints

Id

Grade

Path(s)

Description

Expression

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(5.0.0)	Claim, Pre-determination or Pre-authorization
Claim.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for claim
Claim.status	S This element must be supported.	1..1	code	Status of current claim Binding: FMStatusVS (0.11.1) (required)
Claim.type	S This element must be supported.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeVS (0.11.1) (required)
Claim.use	S This element must be supported.	1..1	code	preauthorization | predetermination | claim Binding: ClaimUseVS (0.11.1) (required)
Claim.patient	S This element must be supported.	1..1	Reference(UZ Core Patient(0.11.1))	The recipient of the products and services
Claim.created	S This element must be supported.	1..1	dateTime	Resource creation date
Claim.insurer	S This element must be supported.	0..1	Reference(UZ Core Organization(0.11.1))	Target
Claim.provider	S This element must be supported.	0..1	Reference(UZ Core Organization(0.11.1))	Party responsible for the claim
Claim.prescription	S This element must be supported.	0..1	Reference(UZ Core MedicationRequest(0.11.1))	Refers to the reimbursement prescription.
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility	S This element must be supported.	0..1	Reference(UZ Core Location(0.11.1) | UZ Core Organization(0.11.1))	Servicing facility
Claim.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept, Reference(Condition)	Nature of illness or problem
Claim.insurance	S This element must be supported.	0..*	BackboneElement	Patient insurance information
Claim.insurance.focal	S This element must be supported.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.coverage	S This element must be supported.	1..1	Reference(Coverage)	Insurance information
Claim.total	S This element must be supported.	0..1	Money	Total claim cost
Claim.total.value	S This element must be supported.	0..1	decimal	Numerical value (with implicit precision)
Claim.total.currency	S This element must be supported.	0..1	code	ISO 4217 currency code Binding: Currencies (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Management Status Value set	📍0.11.1	This IG
Claim.type	Base	required	Claim Type VS	📍0.11.1	This IG
Claim.use	Base	required	Claim Use Value set	📍0.11.1	This IG
Claim.total.currency	Base	required	Currencies	📍5.0.0	FHIR Std.

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(5.0.0)	Claim, Pre-determination or Pre-authorization
Claim.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Claim.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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 Constraints: ext-1
Claim.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
Claim.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for claim
Claim.traceNumber		0..*	Identifier	Number for tracking
Claim.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	Status of current claim Binding: FMStatusVS (0.11.1) (required)
Claim.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeVS (0.11.1) (required)
Claim.subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	preauthorization | predetermination | claim Binding: ClaimUseVS (0.11.1) (required)
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(UZ Core Patient(0.11.1))	The recipient of the products and services
Claim.billablePeriod	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		0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Author of the claim
Claim.insurer	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(UZ Core Organization(0.11.1))	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(UZ Core Organization(0.11.1))	Party responsible for the claim
Claim.priority	Σ This element is included in summaries.	0..1	CodeableConcept	Desired processing urgency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: FundsReservationCodes (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 Constraints: ext-1
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 Constraints: ext-1
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	S This element must be supported.	0..1	Reference(UZ Core MedicationRequest(0.11.1))	Refers to the reimbursement prescription.
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 Constraints: ext-1
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 Constraints: ext-1
Claim.payee.type		1..1	CodeableConcept	Category of recipient Binding: ClaimPayeeTypeCodes (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.encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments
Claim.facility	S This element must be supported.	0..1	Reference(UZ Core Location(0.11.1) | UZ Core Organization(0.11.1))	Servicing facility
Claim.diagnosisRelatedGroup		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example)
Claim.event		0..*	BackboneElement	Event information
Claim.event.id		0..1	string	Unique id for inter-element referencing
Claim.event.extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
Claim.event.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
Claim.event.type		1..1	CodeableConcept	Specific event Binding: DatesTypeCodes (example)
Claim.event.when[x]		1..1		Occurance date or period
Claim.event.when[x].whenDateTime			dateTime
Claim.event.when[x].whenPeriod			Period
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 Constraints: ext-1
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 Constraints: ext-1
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.specialty		0..1	CodeableConcept	Practitioner or provider specialization Binding: ExampleProviderQualificationCodes (example)
Claim.supportingInfo		0..*	BackboneElement	Supporting information
Claim.supportingInfo.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
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 Constraints: ext-1
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.supportingInfo.timing[x]		0..1		When it occurred
Claim.supportingInfo.timing[x].timingDate			date
Claim.supportingInfo.timing[x].timingPeriod			Period
Claim.supportingInfo.value[x]		0..1		Data to be provided
Claim.supportingInfo.value[x].valueBoolean			boolean
Claim.supportingInfo.value[x].valueString			string
Claim.supportingInfo.value[x].valueQuantity			Quantity
Claim.supportingInfo.value[x].valueAttachment			Attachment
Claim.supportingInfo.value[x].valueReference			Reference(Resource)
Claim.supportingInfo.value[x].valueIdentifier			Identifier
Claim.supportingInfo.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis	S This element must be supported.	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 Constraints: ext-1
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 Constraints: ext-1
Claim.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1		Nature of illness or problem Binding: ICD10Codes (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.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 Constraints: ext-1
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 Constraints: ext-1
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: ICD10ProcedureCodes (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.	0..*	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 Constraints: ext-1
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 Constraints: ext-1
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	S This element must be supported. Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident		0..1	BackboneElement	Details of the event
Claim.accident.id		0..1	string	Unique id for inter-element referencing
Claim.accident.extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
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 Constraints: ext-1
Claim.accident.date		1..1	date	When the incident occurred
Claim.accident.type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (3.0.0) (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.patientPaid		0..1	Money	Paid by the patient
Claim.item		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 Constraints: ext-1
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 Constraints: ext-1
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
Claim.item.request		0..*	Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription)	Request or Referral for Service
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 or dates of service or product delivery
Claim.item.serviced[x].servicedDate			date
Claim.item.serviced[x].servicedPeriod			Period
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.patientPaid		0..1	Money	Paid by the patient
Claim.item.quantity	C	0..1	SimpleQuantity(5.0.0)	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.tax		0..1	Money	Total tax
Claim.item.net		0..1	Money	Total item cost
Claim.item.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.bodySite		0..*	BackboneElement	Anatomical location
Claim.item.bodySite.id		0..1	string	Unique id for inter-element referencing
Claim.item.bodySite.extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
Claim.item.bodySite.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
Claim.item.bodySite.site		1..*	CodeableReference(BodyStructure)	Location Binding: OralSiteCodes (example)
Claim.item.bodySite.subSite		0..*	CodeableConcept	Sub-location Binding: SurfaceCodes (example)
Claim.item.encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments
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 Constraints: ext-1
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 Constraints: ext-1
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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.patientPaid		0..1	Money	Paid by the patient
Claim.item.detail.quantity	C	0..1	SimpleQuantity(5.0.0)	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.tax		0..1	Money	Total tax
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 Constraints: ext-1
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 Constraints: ext-1
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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.patientPaid		0..1	Money	Paid by the patient
Claim.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(5.0.0)	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.tax		0..1	Money	Total tax
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.total	S This element must be supported.	0..1	Money	Total claim cost
Claim.total.id		0..1	id	Unique id for inter-element referencing
Claim.total.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
Claim.total.value	S This element must be supported. Σ This element is included in summaries.	0..1	decimal	Numerical value (with implicit precision)
Claim.total.currency	S This element must be supported. Σ This element is included in summaries.	0..1	code	ISO 4217 currency code Binding: Currencies (required)
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.language	Base	required	All Languages	📍5.0.0	FHIR Std.
Claim.status	Base	required	Financial Management Status Value set	📍0.11.1	This IG
Claim.type	Base	required	Claim Type VS	📍0.11.1	This IG
Claim.subType	Base	example	Example Claim SubType Codes	📍5.0.0	FHIR Std.
Claim.use	Base	required	Claim Use Value set	📍0.11.1	This IG
Claim.priority	Base	example	Process Priority Codes	📍5.0.0	FHIR Std.
Claim.fundsReserve	Base	example	Funds Reservation Codes	📍5.0.0	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍5.0.0	FHIR Std.
Claim.payee.type	Base	example	Claim Payee Type Codes	📍5.0.0	FHIR Std.
Claim.diagnosisRelatedGroup	Base	example	Example Diagnosis Related Group Codes	📍5.0.0	FHIR Std.
Claim.event.type	Base	example	Dates Type Codes	📍5.0.0	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍5.0.0	FHIR Std.
Claim.careTeam.specialty	Base	example	Example Provider Qualification Codes	📍5.0.0	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍5.0.0	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍5.0.0	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍5.0.0	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍5.0.0	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍5.0.0	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍5.0.0	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍5.0.0	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍5.0.0	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📍3.0.0	THO v7.3
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍5.0.0	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍5.0.0	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍5.0.0	FHIR Std.
Claim.item.bodySite.​site	Base	example	Oral Site Codes	📍5.0.0	FHIR Std.
Claim.item.bodySite.​subSite	Base	example	Surface Codes	📍5.0.0	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍5.0.0	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.detail.productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍5.0.0	FHIR Std.
Claim.total.currency	Base	required	Currencies	📍5.0.0	FHIR Std.

Constraints

Id

Grade

Path(s)

Description

Expression

This structure is derived from Claim

Summary

Must-Support: 19 elements

Structures

This structure refers to these other structures:

• UZ Core Patient (https://dhp.uz/fhir/core/StructureDefinition/uz-core-patient|0.11.1)
• UZ Core Organization (https://dhp.uz/fhir/core/StructureDefinition/uz-core-organization|0.11.1)
• UZ Core MedicationRequest (https://dhp.uz/fhir/core/StructureDefinition/uz-core-medicationrequest|0.11.1)
• UZ Core Location (https://dhp.uz/fhir/core/StructureDefinition/uz-core-location|0.11.1)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(5.0.0)	Claim, Pre-determination or Pre-authorization
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.contained		0..*	Resource	Contained, inline Resources
Claim.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
Claim.identifier	S This element must be supported.	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	Status of current claim Binding: FMStatusVS (0.11.1) (required)
Claim.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeVS (0.11.1) (required)
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	preauthorization | predetermination | claim Binding: ClaimUseVS (0.11.1) (required)
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(UZ Core Patient(0.11.1))	The recipient of the products and services
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.insurer	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(UZ Core Organization(0.11.1))	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(UZ Core Organization(0.11.1))	Party responsible for the claim
Claim.prescription	S This element must be supported.	0..1	Reference(UZ Core MedicationRequest(0.11.1))	Refers to the reimbursement prescription.
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility	S This element must be supported.	0..1	Reference(UZ Core Location(0.11.1) | UZ Core Organization(0.11.1))	Servicing facility
Claim.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
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 Constraints: ext-1
Claim.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1		Nature of illness or problem Binding: ICD10Codes (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept			CodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReference			Reference(Condition)
Claim.insurance	S This element must be supported. Σ This element is included in summaries.	0..*	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 Constraints: ext-1
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	S This element must be supported. Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.total	S This element must be supported.	0..1	Money	Total claim cost
Claim.total.value	S This element must be supported. Σ This element is included in summaries.	0..1	decimal	Numerical value (with implicit precision)
Claim.total.currency	S This element must be supported. Σ This element is included in summaries.	0..1	code	ISO 4217 currency code Binding: Currencies (required)
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Management Status Value set	📍0.11.1	This IG
Claim.type	Base	required	Claim Type VS	📍0.11.1	This IG
Claim.use	Base	required	Claim Use Value set	📍0.11.1	This IG
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍5.0.0	FHIR Std.
Claim.total.currency	Base	required	Currencies	📍5.0.0	FHIR Std.

Constraints

Id

Grade

Path(s)

Description

Expression

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(5.0.0)	Claim, Pre-determination or Pre-authorization
Claim.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for claim
Claim.status	S This element must be supported.	1..1	code	Status of current claim Binding: FMStatusVS (0.11.1) (required)
Claim.type	S This element must be supported.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeVS (0.11.1) (required)
Claim.use	S This element must be supported.	1..1	code	preauthorization | predetermination | claim Binding: ClaimUseVS (0.11.1) (required)
Claim.patient	S This element must be supported.	1..1	Reference(UZ Core Patient(0.11.1))	The recipient of the products and services
Claim.created	S This element must be supported.	1..1	dateTime	Resource creation date
Claim.insurer	S This element must be supported.	0..1	Reference(UZ Core Organization(0.11.1))	Target
Claim.provider	S This element must be supported.	0..1	Reference(UZ Core Organization(0.11.1))	Party responsible for the claim
Claim.prescription	S This element must be supported.	0..1	Reference(UZ Core MedicationRequest(0.11.1))	Refers to the reimbursement prescription.
Claim.referral	S This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility	S This element must be supported.	0..1	Reference(UZ Core Location(0.11.1) | UZ Core Organization(0.11.1))	Servicing facility
Claim.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept, Reference(Condition)	Nature of illness or problem
Claim.insurance	S This element must be supported.	0..*	BackboneElement	Patient insurance information
Claim.insurance.focal	S This element must be supported.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.coverage	S This element must be supported.	1..1	Reference(Coverage)	Insurance information
Claim.total	S This element must be supported.	0..1	Money	Total claim cost
Claim.total.value	S This element must be supported.	0..1	decimal	Numerical value (with implicit precision)
Claim.total.currency	S This element must be supported.	0..1	code	ISO 4217 currency code Binding: Currencies (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Management Status Value set	📍0.11.1	This IG
Claim.type	Base	required	Claim Type VS	📍0.11.1	This IG
Claim.use	Base	required	Claim Use Value set	📍0.11.1	This IG
Claim.total.currency	Base	required	Currencies	📍5.0.0	FHIR Std.

Snapshot ViewView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(5.0.0)	Claim, Pre-determination or Pre-authorization
Claim.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Claim.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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 Constraints: ext-1
Claim.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
Claim.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for claim
Claim.traceNumber		0..*	Identifier	Number for tracking
Claim.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	Status of current claim Binding: FMStatusVS (0.11.1) (required)
Claim.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeVS (0.11.1) (required)
Claim.subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	preauthorization | predetermination | claim Binding: ClaimUseVS (0.11.1) (required)
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(UZ Core Patient(0.11.1))	The recipient of the products and services
Claim.billablePeriod	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		0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Author of the claim
Claim.insurer	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(UZ Core Organization(0.11.1))	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(UZ Core Organization(0.11.1))	Party responsible for the claim
Claim.priority	Σ This element is included in summaries.	0..1	CodeableConcept	Desired processing urgency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: FundsReservationCodes (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 Constraints: ext-1
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 Constraints: ext-1
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	S This element must be supported.	0..1	Reference(UZ Core MedicationRequest(0.11.1))	Refers to the reimbursement prescription.
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 Constraints: ext-1
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 Constraints: ext-1
Claim.payee.type		1..1	CodeableConcept	Category of recipient Binding: ClaimPayeeTypeCodes (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.encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments
Claim.facility	S This element must be supported.	0..1	Reference(UZ Core Location(0.11.1) | UZ Core Organization(0.11.1))	Servicing facility
Claim.diagnosisRelatedGroup		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example)
Claim.event		0..*	BackboneElement	Event information
Claim.event.id		0..1	string	Unique id for inter-element referencing
Claim.event.extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
Claim.event.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
Claim.event.type		1..1	CodeableConcept	Specific event Binding: DatesTypeCodes (example)
Claim.event.when[x]		1..1		Occurance date or period
Claim.event.when[x].whenDateTime			dateTime
Claim.event.when[x].whenPeriod			Period
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 Constraints: ext-1
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 Constraints: ext-1
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.specialty		0..1	CodeableConcept	Practitioner or provider specialization Binding: ExampleProviderQualificationCodes (example)
Claim.supportingInfo		0..*	BackboneElement	Supporting information
Claim.supportingInfo.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
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 Constraints: ext-1
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.supportingInfo.timing[x]		0..1		When it occurred
Claim.supportingInfo.timing[x].timingDate			date
Claim.supportingInfo.timing[x].timingPeriod			Period
Claim.supportingInfo.value[x]		0..1		Data to be provided
Claim.supportingInfo.value[x].valueBoolean			boolean
Claim.supportingInfo.value[x].valueString			string
Claim.supportingInfo.value[x].valueQuantity			Quantity
Claim.supportingInfo.value[x].valueAttachment			Attachment
Claim.supportingInfo.value[x].valueReference			Reference(Resource)
Claim.supportingInfo.value[x].valueIdentifier			Identifier
Claim.supportingInfo.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis	S This element must be supported.	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 Constraints: ext-1
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 Constraints: ext-1
Claim.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1		Nature of illness or problem Binding: ICD10Codes (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.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 Constraints: ext-1
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 Constraints: ext-1
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: ICD10ProcedureCodes (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.	0..*	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 Constraints: ext-1
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 Constraints: ext-1
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	S This element must be supported. Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident		0..1	BackboneElement	Details of the event
Claim.accident.id		0..1	string	Unique id for inter-element referencing
Claim.accident.extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
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 Constraints: ext-1
Claim.accident.date		1..1	date	When the incident occurred
Claim.accident.type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (3.0.0) (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.patientPaid		0..1	Money	Paid by the patient
Claim.item		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 Constraints: ext-1
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 Constraints: ext-1
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
Claim.item.request		0..*	Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription)	Request or Referral for Service
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 or dates of service or product delivery
Claim.item.serviced[x].servicedDate			date
Claim.item.serviced[x].servicedPeriod			Period
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.patientPaid		0..1	Money	Paid by the patient
Claim.item.quantity	C	0..1	SimpleQuantity(5.0.0)	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.tax		0..1	Money	Total tax
Claim.item.net		0..1	Money	Total item cost
Claim.item.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.bodySite		0..*	BackboneElement	Anatomical location
Claim.item.bodySite.id		0..1	string	Unique id for inter-element referencing
Claim.item.bodySite.extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
Claim.item.bodySite.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
Claim.item.bodySite.site		1..*	CodeableReference(BodyStructure)	Location Binding: OralSiteCodes (example)
Claim.item.bodySite.subSite		0..*	CodeableConcept	Sub-location Binding: SurfaceCodes (example)
Claim.item.encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments
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 Constraints: ext-1
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 Constraints: ext-1
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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.patientPaid		0..1	Money	Paid by the patient
Claim.item.detail.quantity	C	0..1	SimpleQuantity(5.0.0)	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.tax		0..1	Money	Total tax
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 Constraints: ext-1
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 Constraints: ext-1
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.traceNumber		0..*	Identifier	Number for tracking
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		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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.patientPaid		0..1	Money	Paid by the patient
Claim.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(5.0.0)	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.tax		0..1	Money	Total tax
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.total	S This element must be supported.	0..1	Money	Total claim cost
Claim.total.id		0..1	id	Unique id for inter-element referencing
Claim.total.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
Claim.total.value	S This element must be supported. Σ This element is included in summaries.	0..1	decimal	Numerical value (with implicit precision)
Claim.total.currency	S This element must be supported. Σ This element is included in summaries.	0..1	code	ISO 4217 currency code Binding: Currencies (required)
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.language	Base	required	All Languages	📍5.0.0	FHIR Std.
Claim.status	Base	required	Financial Management Status Value set	📍0.11.1	This IG
Claim.type	Base	required	Claim Type VS	📍0.11.1	This IG
Claim.subType	Base	example	Example Claim SubType Codes	📍5.0.0	FHIR Std.
Claim.use	Base	required	Claim Use Value set	📍0.11.1	This IG
Claim.priority	Base	example	Process Priority Codes	📍5.0.0	FHIR Std.
Claim.fundsReserve	Base	example	Funds Reservation Codes	📍5.0.0	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍5.0.0	FHIR Std.
Claim.payee.type	Base	example	Claim Payee Type Codes	📍5.0.0	FHIR Std.
Claim.diagnosisRelatedGroup	Base	example	Example Diagnosis Related Group Codes	📍5.0.0	FHIR Std.
Claim.event.type	Base	example	Dates Type Codes	📍5.0.0	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍5.0.0	FHIR Std.
Claim.careTeam.specialty	Base	example	Example Provider Qualification Codes	📍5.0.0	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍5.0.0	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍5.0.0	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍5.0.0	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍5.0.0	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍5.0.0	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍5.0.0	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍5.0.0	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍5.0.0	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📍3.0.0	THO v7.3
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍5.0.0	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍5.0.0	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍5.0.0	FHIR Std.
Claim.item.bodySite.​site	Base	example	Oral Site Codes	📍5.0.0	FHIR Std.
Claim.item.bodySite.​subSite	Base	example	Surface Codes	📍5.0.0	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍5.0.0	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.detail.productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍5.0.0	FHIR Std.
Claim.total.currency	Base	required	Currencies	📍5.0.0	FHIR Std.

Constraints

Id

Grade

Path(s)

Description

Expression

This structure is derived from Claim

Summary

Must-Support: 19 elements

Structures

This structure refers to these other structures:

• UZ Core Patient (https://dhp.uz/fhir/core/StructureDefinition/uz-core-patient|0.11.1)
• UZ Core Organization (https://dhp.uz/fhir/core/StructureDefinition/uz-core-organization|0.11.1)
• UZ Core MedicationRequest (https://dhp.uz/fhir/core/StructureDefinition/uz-core-medicationrequest|0.11.1)
• UZ Core Location (https://dhp.uz/fhir/core/StructureDefinition/uz-core-location|0.11.1)