This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2
Detailed Descriptions for the elements in the Claim resource.
Claim | |
Definition | A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery. |
Control | 1..1 |
Summary | true |
Claim.type | |
Definition | The category of claim. |
Control | 1..1 |
Binding | ClaimType: The type or discipline-style of the claim (Required) |
Type | code |
Summary | true |
Comments | Affects which fields and value sets are used. |
Claim.subType | |
Definition | A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType. |
Control | 0..* |
Binding | Example Claim SubType Codes: A more granulat claim typecode (Example) |
Type | Coding |
Summary | true |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Claim.identifier | |
Definition | The business identifier for the instance: claim number, pre-determination or pre-authorization number. |
Note | This is a business identifer, not a resource identifier (see discussion) |
Control | 0..* |
Type | Identifier |
Summary | true |
Claim.ruleset | |
Definition | The version of the specification on which this instance relies. |
Control | 0..1 |
Binding | Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example) |
Type | Coding |
Alternate Names | BusinessVersion |
Summary | true |
Claim.originalRuleset | |
Definition | The version of the specification from which the original instance was created. |
Control | 0..1 |
Binding | Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example) |
Type | Coding |
Alternate Names | OriginalBusinessVersion |
Summary | true |
Claim.created | |
Definition | The date when the enclosed suite of services were performed or completed. |
Control | 0..1 |
Type | dateTime |
Summary | true |
Claim.billablePeriod | |
Definition | The billable period for which charges are being submitted. |
Control | 0..1 |
Type | Period |
Summary | true |
Claim.target[x] | |
Definition | Insurer Identifier, typical BIN number (6 digit). |
Control | 0..1 |
Type | Identifier|Reference(Organization) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.provider[x] | |
Definition | The provider which is responsible for the bill, claim pre-determination, pre-authorization. |
Control | 0..1 |
Type | Identifier|Reference(Practitioner) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.organization[x] | |
Definition | The organization which is responsible for the bill, claim pre-determination, pre-authorization. |
Control | 0..1 |
Type | Identifier|Reference(Organization) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.use | |
Definition | Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination). |
Control | 0..1 |
Binding | Use: Complete, proposed, exploratory, other (Required) |
Type | code |
Summary | true |
Claim.priority | |
Definition | Immediate (STAT), best effort (NORMAL), deferred (DEFER). |
Control | 0..1 |
Binding | Priority Codes: The timeliness with which processing is required: STAT, normal, Deferred (Example) |
Type | Coding |
Summary | true |
Claim.fundsReserve | |
Definition | In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested. |
Control | 0..1 |
Binding | Funds Reservation Codes: For whom funds are to be reserved: (Patient, Provider, None). (Example) |
Type | Coding |
Summary | true |
Claim.enterer[x] | |
Definition | Person who created the invoice/claim/pre-determination or pre-authorization. |
Control | 0..1 |
Type | Identifier|Reference(Practitioner) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.facility[x] | |
Definition | Facility where the services were provided. |
Control | 0..1 |
Type | Identifier|Reference(Location) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.related | |
Definition | Other claims which are related to this claim such as prior claim versions or for related services. |
Control | 0..* |
Summary | true |
Claim.related.claim[x] | |
Definition | Other claims which are related to this claim such as prior claim versions or for related services. |
Control | 0..1 |
Type | Identifier|Reference(Claim) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Comments | Do we need a relationship code? |
Claim.related.relationship | |
Definition | For example prior or umbrella. |
Control | 0..1 |
Binding | Example Related Claim Relationship Codes: Relationship of this claim to a related Claim (Example) |
Type | Coding |
Summary | true |
Claim.related.reference | |
Definition | An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # . |
Control | 0..1 |
Type | Identifier |
Summary | true |
Claim.prescription[x] | |
Definition | Prescription to support the dispensing of Pharmacy or Vision products. |
Control | 0..1 |
Type | Identifier|Reference(MedicationOrder | VisionPrescription) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | For type=Pharmacy and Vision only. |
Summary | true |
Comments | Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence. |
Claim.originalPrescription[x] | |
Definition | Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. |
Control | 0..1 |
Type | Identifier|Reference(MedicationOrder) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Comments | as above. |
Claim.payee | |
Definition | The party to be reimbursed for the services. |
Control | 0..1 |
Summary | true |
Claim.payee.type | |
Definition | Type of Party to be reimbursed: Subscriber, provider, other. |
Control | 1..1 |
Binding | Payee Type Codes: A code for the party to be reimbursed. (Example) |
Type | Coding |
Summary | true |
Claim.payee.party[x] | |
Definition | Party to be reimbursed: Subscriber, provider, other. |
Control | 0..1 |
Type | Identifier|Reference(Practitioner | Organization | Patient | RelatedPerson) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.referral[x] | |
Definition | The referral resource which lists the date, practitioner, reason and other supporting information. |
Control | 0..1 |
Type | Identifier|Reference(ReferralRequest) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.occurrenceCode | |
Definition | **Insert definition of Occurrence codes. |
Control | 0..* |
Binding | Example Occurrance Codes: Occurrence codes (Example) |
Type | Coding |
Summary | true |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Claim.occurenceSpanCode | |
Definition | **Insert definition of Occurrence Span codes. |
Control | 0..* |
Binding | Example Occurrance Span Codes: Occurrence Span codes (Example) |
Type | Coding |
Summary | true |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Claim.valueCode | |
Definition | **Insert definition of Value codes. |
Control | 0..* |
Binding | Example Value Codes: Value code (Example) |
Type | Coding |
Summary | true |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Claim.diagnosis | |
Definition | Ordered list of patient diagnosis for which care is sought. |
Control | 0..* |
Summary | true |
Claim.diagnosis.sequence | |
Definition | Sequence of diagnosis which serves to order and provide a link. |
Control | 1..1 |
Type | positiveInt |
Requirements | Required to maintain order of the diagnoses. |
Summary | true |
Claim.diagnosis.diagnosis | |
Definition | The diagnosis. |
Control | 1..1 |
Binding | ICD-10 Codes: ICD10 Diagnostic codes (Example) |
Type | Coding |
Requirements | Required to adjudicate services rendered to condition presented. |
Summary | true |
Claim.procedure | |
Definition | Ordered list of patient procedures performed to support the adjudication. |
Control | 0..* |
Summary | true |
Claim.procedure.sequence | |
Definition | Sequence of procedures which serves to order and provide a link. |
Control | 1..1 |
Type | positiveInt |
Requirements | Required to maintain order of the procudures. |
Summary | true |
Claim.procedure.date | |
Definition | Date and optionally time the procedure was performed . |
Control | 0..1 |
Type | dateTime |
Requirements | Required to adjudicate services rendered. |
Summary | true |
Comments | SB DateTime?? |
Claim.procedure.procedure[x] | |
Definition | The procedure code. |
Control | 1..1 |
Binding | ICD-10 Procedure Codes: ICD10 Procedure codes (Example) |
Type | Coding|Reference(Procedure) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | Required to adjudicate services rendered. |
Summary | true |
Claim.specialCondition | |
Definition | List of special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication. |
Control | 0..* |
Binding | Conditions Codes: Patient conditions and symptoms (Example) |
Type | Coding |
Summary | true |
Claim.patient[x] | |
Definition | Patient Resource. |
Control | 1..1 |
Type | Identifier|Reference(Patient) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.coverage | |
Definition | Financial instrument by which payment information for health care. |
Control | 0..* |
Requirements | Health care programs and insurers are significant payors of health service costs. |
Summary | true |
Claim.coverage.sequence | |
Definition | A service line item. |
Control | 1..1 |
Type | positiveInt |
Requirements | To maintain order of the coverages. |
Summary | true |
Claim.coverage.focal | |
Definition | The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated. |
Control | 1..1 |
Type | boolean |
Requirements | To identify which coverage is being adjudicated. |
Summary | true |
Claim.coverage.coverage[x] | |
Definition | Reference to the program or plan identification, underwriter or payor. |
Control | 1..1 |
Type | Identifier|Reference(Coverage) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | Need to identify the issuer to target for processing and for coordination of benefit processing. |
Summary | true |
Claim.coverage.businessArrangement | |
Definition | The contract number of a business agreement which describes the terms and conditions. |
Control | 0..1 |
Type | string |
Summary | true |
Claim.coverage.preAuthRef | |
Definition | A list of references from the Insurer to which these services pertain. |
Control | 0..* |
Type | string |
Requirements | To provide any pre=determination or prior authorization reference. |
Summary | true |
Claim.coverage.claimResponse | |
Definition | The Coverages adjudication details. |
Control | 0..1 |
Type | Reference(ClaimResponse) |
Requirements | Used by downstream payers to determine what balance remains and the net payable. |
Summary | true |
Claim.coverage.originalRuleset | |
Definition | The style (standard) and version of the original material which was converted into this resource. |
Control | 0..1 |
Binding | Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example) |
Type | Coding |
Requirements | Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated. |
Summary | true |
Claim.accidentDate | |
Definition | Date of an accident which these services are addressing. |
Control | 0..1 |
Type | date |
Requirements | Coverage may be dependant on accidents. |
Summary | true |
Claim.accidentType | |
Definition | Type of accident: work, auto, etc. |
Control | 0..1 |
Binding | ActIncidentCode: Type of accident: work place, auto, etc. (Required) |
Type | Coding |
Requirements | Coverage may be dependant on the type of accident. |
Summary | true |
Claim.accidentLocation[x] | |
Definition | Accident Place. |
Control | 0..1 |
Type | Address|Reference(Location) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.interventionException | |
Definition | A list of intervention and exception codes which may influence the adjudication of the claim. |
Control | 0..* |
Binding | Intervention Codes: Intervention and exception codes (Pharm) (Example) |
Type | Coding |
Requirements | Coverage may be modified based on exception information provided. |
Summary | true |
Claim.onset | |
Definition | Period, start and last dates of aspects of the Condition or related services. |
Control | 0..* |
Summary | true |
Claim.onset.time[x] | |
Definition | The start or start and end dates for the treatable condition. |
Control | 0..1 |
Type | date|Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.onset.type | |
Definition | Onset typifications eg. Start of pregnancy, start of illnes, etc. |
Control | 0..1 |
Binding | Example Onset Type (Reason) Codes: Condition related start, end and period codes (Example) |
Type | Coding |
Summary | true |
Claim.employmentImpacted | |
Definition | The start and optional end dates of when the patient was precluded from working due to the treatable condition(s). |
Control | 0..1 |
Type | Period |
Summary | true |
Claim.hospitalization | |
Definition | The start and optional end dates of when the patient was confined to a treatment center. |
Control | 0..1 |
Type | Period |
Summary | true |
Claim.item | |
Definition | First tier of goods and services. |
Control | 0..* |
Summary | true |
Claim.item.sequence | |
Definition | A service line number. |
Control | 1..1 |
Type | positiveInt |
Summary | true |
Claim.item.type | |
Definition | The type of product or service. |
Control | 1..1 |
Binding | Exception Codes: Group, Service, Product. (Required) |
Type | Coding |
Summary | true |
Claim.item.provider[x] | |
Definition | The practitioner who is responsible for the services rendered to the patient. |
Control | 0..1 |
Type | Identifier|Reference(Practitioner) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.item.supervisor[x] | |
Definition | The practitioner who is supervising the work of the servicing provider(s). |
Control | 0..1 |
Type | Identifier|Reference(Practitioner) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.item.providerQualification | |
Definition | The qualification which is applicable for this service. |
Control | 0..1 |
Binding | Example Provider Qualification Codes: Provider professional qualifications (Example) |
Type | Coding |
Summary | true |
Claim.item.diagnosisLinkId | |
Definition | Diagnosis applicable for this service or product line. |
Control | 0..* |
Type | positiveInt |
Summary | true |
Claim.item.service | |
Definition | If a grouping item then 'GROUP' otherwise it is a node therefore a code to indicate the Professional Service or Product supplied. |
Control | 1..1 |
Binding | USCLS Codes: Allowable service and product codes (Example) |
Type | Coding |
Summary | true |
Claim.item.serviceModifier | |
Definition | Unusual circumstances which may influence adjudication. |
Control | 0..* |
Binding | Example Service Modifier Codes: Factors which may influce adjudication of services (Example) |
Type | Coding |
Requirements | May impact on adjudication. |
Summary | true |
Claim.item.modifier | |
Definition | Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
Control | 0..* |
Binding | Modifier type Codes: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. (Example) |
Type | Coding |
Requirements | May impact on adjudication. |
Summary | true |
Claim.item.programCode | |
Definition | For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program. |
Control | 0..* |
Binding | Example Program Reason Codes: Program specific reason codes (Example) |
Type | Coding |
Summary | true |
Claim.item.serviced[x] | |
Definition | The date or dates when the enclosed suite of services were performed or completed. |
Control | 0..1 |
Type | date|Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Summary | true |
Claim.item.place | |
Definition | Where the service was provided. |
Control | 0..1 |
Binding | Example Service Place Codes: (Example) |
Type | Coding |
Summary | true |
Claim.item.quantity | |
Definition | The number of repetitions of a service or product. |
Control | 0..1 |
Type | SimpleQuantity |
Summary | true |
Claim.item.unitPrice | |
Definition | If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group. |
Control | 0..1 |
Type | Money |
Summary | true |
Claim.item.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Control | 0..1 |
Type | decimal |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.points | |
Definition | An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point. |
Control | 0..1 |
Type | decimal |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.net | |
Definition | The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied. |
Control | 0..1 |
Type | Money |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.udi | |
Definition | List of Unique Device Identifiers associated with this line item. |
Control | 0..* |
Type | Reference(Device) |
Requirements | The UDI code and issuer if applicable for the supplied product. |
Summary | true |
Claim.item.bodySite | |
Definition | Physical service site on the patient (limb, tooth, etc). |
Control | 0..1 |
Binding | Oral Site Codes: The code for the teeth, quadrant, sextant and arch (Example) |
Type | Coding |
Summary | true |
Claim.item.subSite | |
Definition | A region or surface of the site, eg. limb region or tooth surface(s). |
Control | 0..* |
Binding | Surface Codes: The code for the tooth surface and surface combinations (Example) |
Type | Coding |
Summary | true |
Claim.item.detail | |
Definition | Second tier of goods and services. |
Control | 0..* |
Summary | true |
Claim.item.detail.sequence | |
Definition | A service line number. |
Control | 1..1 |
Type | positiveInt |
Summary | true |
Claim.item.detail.type | |
Definition | The type of product or service. |
Control | 1..1 |
Binding | Exception Codes: Group, Service, Product. (Required) |
Type | Coding |
Summary | true |
Claim.item.detail.service | |
Definition | If a grouping item then 'GROUP' otherwise it is a node therefore a code to indicate the Professional Service or Product supplied. |
Control | 1..1 |
Binding | USCLS Codes: Allowable service and product codes (Example) |
Type | Coding |
Summary | true |
Claim.item.detail.programCode | |
Definition | For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program. |
Control | 0..* |
Binding | Example Program Reason Codes: Program specific reason codes (Example) |
Type | Coding |
Summary | true |
Claim.item.detail.quantity | |
Definition | The number of repetitions of a service or product. |
Control | 0..1 |
Type | SimpleQuantity |
Summary | true |
Claim.item.detail.unitPrice | |
Definition | If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group. |
Control | 0..1 |
Type | Money |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.detail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Control | 0..1 |
Type | decimal |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.detail.points | |
Definition | An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point. |
Control | 0..1 |
Type | decimal |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.detail.net | |
Definition | The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied. |
Control | 0..1 |
Type | Money |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.detail.udi | |
Definition | List of Unique Device Identifiers associated with this line item. |
Control | 0..* |
Type | Reference(Device) |
Requirements | The UDI code and issuer if applicable for the supplied product. |
Summary | true |
Claim.item.detail.subDetail | |
Definition | Third tier of goods and services. |
Control | 0..* |
Summary | true |
Claim.item.detail.subDetail.sequence | |
Definition | A service line number. |
Control | 1..1 |
Type | positiveInt |
Summary | true |
Claim.item.detail.subDetail.type | |
Definition | The type of product or service. |
Control | 1..1 |
Binding | Exception Codes: Group, Service, Product. (Required) |
Type | Coding |
Summary | true |
Claim.item.detail.subDetail.service | |
Definition | The fee for an addittional service or product or charge. |
Control | 1..1 |
Binding | USCLS Codes: Allowable service and product codes (Example) |
Type | Coding |
Summary | true |
Claim.item.detail.subDetail.programCode | |
Definition | For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program. |
Control | 0..* |
Binding | Example Program Reason Codes: Program specific reason codes (Example) |
Type | Coding |
Summary | true |
Claim.item.detail.subDetail.quantity | |
Definition | The number of repetitions of a service or product. |
Control | 0..1 |
Type | SimpleQuantity |
Summary | true |
Claim.item.detail.subDetail.unitPrice | |
Definition | The fee for an addittional service or product or charge. |
Control | 0..1 |
Type | Money |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.detail.subDetail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Control | 0..1 |
Type | decimal |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.detail.subDetail.points | |
Definition | An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point. |
Control | 0..1 |
Type | decimal |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.detail.subDetail.net | |
Definition | The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied. |
Control | 0..1 |
Type | Money |
Requirements | If a fee is present the associated product/service code must be present. |
Summary | true |
Claim.item.detail.subDetail.udi | |
Definition | List of Unique Device Identifiers associated with this line item. |
Control | 0..* |
Type | Reference(Device) |
Requirements | The UDI code and issuer if applicable for the supplied product. |
Summary | true |
Claim.item.prosthesis | |
Definition | The materials and placement date of prior fixed prosthesis. |
Control | 0..1 |
Summary | true |
Claim.item.prosthesis.initial | |
Definition | Indicates whether this is the initial placement of a fixed prosthesis. |
Control | 0..1 |
Type | boolean |
Requirements | May impact on adjudication. |
Summary | true |
Claim.item.prosthesis.priorDate | |
Definition | Date of the initial placement. |
Control | 0..1 |
Type | date |
Requirements | May impact on adjudication. |
Summary | true |
Claim.item.prosthesis.priorMaterial | |
Definition | Material of the prior denture or bridge prosthesis. (Oral). |
Control | 0..1 |
Binding | Oral Prostho Material type Codes: Material of the prior denture or bridge prosthesis. (Oral) (Example) |
Type | Coding |
Requirements | May impact on adjudication. |
Summary | true |
Claim.total | |
Definition | The total value of the claim. |
Control | 0..1 |
Type | Money |
Summary | true |
Claim.additionalMaterial | |
Definition | Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission. |
Control | 0..* |
Binding | Additional Material Codes: Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission. (Example) |
Type | Coding |
Summary | true |
Claim.missingTeeth | |
Definition | A list of teeth which would be expected but are not found due to having been previously extracted or for other reasons. |
Control | 0..* |
Requirements | The list of missing teeth may influence the adjudication of services for example with Bridges. |
Summary | true |
Claim.missingTeeth.tooth | |
Definition | The code identifying which tooth is missing. |
Control | 1..1 |
Binding | Teeth Codes: The codes for the teeth, subset of OralSites (Example) |
Type | Coding |
Requirements | Provides the tooth number of the missing tooth. |
Summary | true |
Claim.missingTeeth.reason | |
Definition | Missing reason may be: E-extraction, O-other. |
Control | 0..1 |
Binding | Missing Tooth Reason Codes: Reason codes for the missing teeth (Example) |
Type | Coding |
Requirements | Provides the reason for the missing tooth. |
Summary | true |
Claim.missingTeeth.extractionDate | |
Definition | The date of the extraction either known from records or patient reported estimate. |
Control | 0..1 |
Type | date |
Requirements | Some services and adjudications require this information. |
Summary | true |