Consumer Real-Time Pharmacy Benefit Check
1.0.0 - STU1
Consumer Real-Time Pharmacy Benefit Check
1.0.0 - STU1
This page is part of the Consumer Real-time Pharmacy Benefit Check (v1.0.0: STU 1) based on FHIR R4. This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions 
This profile constrains the Claim resource so that it can serve as the RTPBC Request in the consumer real-time pharmacy benefit check process
The official URL for this profile is:
http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim
This profile constrains the Claim resource so that it can serve as the request in the consumer Real-time Pharmacy Benefit Check (RTPBC) process.
Data population is similar to a typical Claim predetermination request (where Claim.use set to “predetermination”), with the following key differences:
Certain elements are fixed to values reflecting a medication-related request…
In addition, no pricing / cost information is submitted in the request since the goal of the exchange is learn the expected cost to the patient rather than reimbursement information for a pharmacy.
In this profile, the Claim references the following supported resources. All are profiled in this guide except Practitioner, which uses the US Core Practitioner profile without further constraints.
Client systems
Responding systems
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Claim
Summary
Mandatory: 29 elements
Must-Support: 42 elements
Fixed Value: 12 elements
Structures
This structure refers to these other structures:
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |
  id | S | 1..1 | string | Unique Claim Resource Identifier |
 identifier | S | 1..1 | Identifier | RTPBC request identifier |
  value | S | 1..1 | string | Unique RTPBC request ID |
| status | S | 1..1 | code | Request status Fixed Value: active |
| type | S | 1..1 | CodeableConcept | Requested Service Type |
 coding | S | 1..1 | Coding | Code defined by a terminology system |
 system | S | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type |
| code | S | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pharmacy |
| display | S | 1..1 | string | Representation defined by the system Fixed Value: Pharmacy |
| use | S | 1..1 | code | Processing Mode Fixed Value: predetermination |
 patient | S | 1..1 | Reference(RTPBC Patient) | Request Patient Information |
| reference | S | 1..1 | string | Patient Reference |
| created | S | 1..1 | dateTime | Created DateTime |
| provider | S | 1..1 | Reference(RTPBC Pharmacy Organization) | Preferred Pharmacy |
| reference | S | 1..1 | string | Reference to Pharmacy Organization |
| priority | S | 1..1 | CodeableConcept | Processing priority |
| coding | S | 1..1 | Coding | Code defined by a terminology system |
| system | S | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority |
| code | S | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal |
| display | S | 1..1 | string | Representation defined by the system Fixed Value: Normal |
| prescription | S | 1..1 | Reference(RTPBC Medication Request) | Prescription Reference |
| reference | S | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| careTeam | S | 1..1 | BackboneElement | Prescriber |
| sequence | S | 1..1 | positiveInt | Order of care team Fixed Value: 1 |
| provider | S | 1..1 | Reference(US Core Practitioner Profile) | Prescriber |
| reference | S | 1..1 | string | Prescriber Reference |
| insurance | S | 1..1 | BackboneElement | Pharmacy Coverage |
| sequence | S | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
| focal | S | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
| coverage | S | 1..1 | Reference(RTPBC Coverage) | Pharmacy Coverage Reference |
| reference | S | 0..1 | string | Pharmacy Coverage Reference |
| item | S | 1..1 | BackboneElement | Max 1 item per request |
| sequence | S | 1..1 | positiveInt | Item instance identifier Fixed Value: 1 |
| careTeamSequence | S | 1..1 | positiveInt | Care Team Sequence ID Reference |
| productOrService | S | 1..1 | CodeableConcept | Prescribed Product Binding: RTPBC Prescribable Product Code Value Set (extensible) |
| coding | S | 1..* | Coding | Code defined by a terminology system |
| system | S | 1..1 | uri | Identity of the terminology system |
| code | S | 1..1 | code | Symbol in syntax defined by the system |
| display | S | 1..1 | string | Product Description |
| quantity | S | 1..1 | SimpleQuantity | Prescribed Quantity |
| value | S | 1..1 | decimal | Quantity in Billing Units |
| unit | S | 1..1 | string | Billing unit of measure Binding: RTPBC Billing Unit Value Set (extensible) |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | I | 0..* | Claim | Claim, Pre-determination or Pre-authorization |
 id | SΣ | 1..1 | string | Unique Claim Resource Identifier |
 meta | ΣI | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!ΣI | 0..1 | uri | A set of rules under which this content was created |
| language | I | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages |
| text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
| contained | 0..* | Resource | Contained, inline Resources | |
 extension | I | 0..* | Extension | Additional content defined by implementations |
 modifierExtension | ?!I | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SI | 1..1 | Identifier | RTPBC request identifier |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| use | ?!ΣI | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required) |
| type | ΣI | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible) |
| system | ΣI | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | SΣI | 1..1 | string | Unique RTPBC request ID Example General: 123456 |
| period | ΣI | 0..1 | Period | Time period when id is/was valid for use |
| assigner | ΣI | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
| status | ?!SΣI | 1..1 | code | Request status Binding: FinancialResourceStatusCodes (required) Fixed Value: active |
| type | SΣI | 1..1 | CodeableConcept | Requested Service Type Binding: ClaimTypeCodes (extensible) |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| coding | SΣI | 1..1 | Coding | Code defined by a terminology system |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| system | SΣI | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type |
| version | ΣI | 0..1 | string | Version of the system - if relevant |
| code | SΣI | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pharmacy |
| display | SΣI | 1..1 | string | Representation defined by the system Fixed Value: Pharmacy |
| userSelected | ΣI | 0..1 | boolean | If this coding was chosen directly by the user |
| text | ΣI | 0..1 | string | Plain text representation of the concept |
| subType | I | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example) |
| use | SΣI | 1..1 | code | Processing Mode Binding: Use (required) Fixed Value: predetermination |
| patient | SΣI | 1..1 | Reference(RTPBC Patient) | Request Patient Information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 1..1 | string | Patient Reference |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| billablePeriod | ΣI | 0..1 | Period | Relevant time frame for the claim |
| created | SΣI | 1..1 | dateTime | Created DateTime |
| enterer | I | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim |
| insurer | ΣI | 0..1 | Reference(Organization) | Target |
| provider | SΣI | 1..1 | Reference(RTPBC Pharmacy Organization) | Preferred Pharmacy |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 1..1 | string | Reference to Pharmacy Organization |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| priority | SΣI | 1..1 | CodeableConcept | Processing priority Binding: ProcessPriorityCodes (example) |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| coding | SΣI | 1..1 | Coding | Code defined by a terminology system |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| system | SΣI | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority |
| version | ΣI | 0..1 | string | Version of the system - if relevant |
| code | SΣI | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal |
| display | SΣI | 1..1 | string | Representation defined by the system Fixed Value: Normal |
| userSelected | ΣI | 0..1 | boolean | If this coding was chosen directly by the user |
| text | ΣI | 0..1 | string | Plain text representation of the concept |
| fundsReserve | I | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example) |
| related | I | 0..* | BackboneElement | Prior or corollary claims |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| claim | I | 0..1 | Reference(Claim) | Reference to the related claim |
| relationship | I | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example) |
| reference | I | 0..1 | Identifier | File or case reference |
| prescription | SI | 1..1 | Reference(RTPBC Medication Request) | Prescription Reference |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| originalPrescription | I | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller |
| payee | I | 0..1 | BackboneElement | Recipient of benefits payable |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | I | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example) |
| party | I | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference |
| referral | I | 0..1 | Reference(ServiceRequest) | Treatment referral |
| facility | I | 0..1 | Reference(Location) | Servicing facility |
| careTeam | SI | 1..1 | BackboneElement | Prescriber |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | SI | 1..1 | positiveInt | Order of care team Fixed Value: 1 |
| provider | SI | 1..1 | Reference(US Core Practitioner Profile) | Prescriber |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 1..1 | string | Prescriber Reference |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| responsible | I | 0..1 | boolean | Indicator of the lead practitioner |
| role | I | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example) |
| qualification | I | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example) |
| supportingInfo | I | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Information instance identifier |
| category | I | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) |
| code | I | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) |
 timing[x] | I | 0..1 | When it occurred | |
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | I | 0..1 | Data to be provided | |
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(Resource) | |||
| reason | I | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) |
| diagnosis | I | 0..* | BackboneElement | Pertinent diagnosis information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Diagnosis instance identifier |
| diagnosis[x] | I | 1..1 | Nature of illness or problem Binding: ICD-10Codes (example) | |
| diagnosisCodeableConcept | CodeableConcept | |||
| diagnosisReference | Reference(Condition) | |||
| type | I | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example) |
| onAdmission | I | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example) |
| packageCode | I | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example) |
| procedure | I | 0..* | BackboneElement | Clinical procedures performed |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Procedure instance identifier |
| type | I | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example) |
| date | I | 0..1 | dateTime | When the procedure was performed |
| procedure[x] | I | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example) | |
| procedureCodeableConcept | CodeableConcept | |||
| procedureReference | Reference(Procedure) | |||
| udi | I | 0..* | Reference(Device) | Unique device identifier |
| insurance | SΣI | 1..1 | BackboneElement | Pharmacy Coverage |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | SΣI | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
| focal | SΣI | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
| identifier | I | 0..1 | Identifier | Pre-assigned Claim number |
| coverage | SΣI | 1..1 | Reference(RTPBC Coverage) | Pharmacy Coverage Reference |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 0..1 | string | Pharmacy Coverage Reference |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| businessArrangement | I | 0..1 | string | Additional provider contract number |
| preAuthRef | I | 0..* | string | Prior authorization reference number |
| claimResponse | I | 0..1 | Reference(ClaimResponse) | Adjudication results |
| accident | I | 0..1 | BackboneElement | Details of the event |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| date | I | 1..1 | date | When the incident occurred |
| type | I | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible) |
| location[x] | I | 0..1 | Where the event occurred | |
| locationAddress | Address | |||
| locationReference | Reference(Location) | |||
| item | SI | 1..1 | BackboneElement | Max 1 item per request |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | SI | 1..1 | positiveInt | Item instance identifier Fixed Value: 1 |
| careTeamSequence | SI | 1..1 | positiveInt | Care Team Sequence ID Reference |
| diagnosisSequence | I | 0..* | positiveInt | Applicable diagnoses |
| procedureSequence | I | 0..* | positiveInt | Applicable procedures |
| informationSequence | I | 0..* | positiveInt | Applicable exception and supporting information |
| revenue | I | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | I | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) |
| productOrService | SI | 1..1 | CodeableConcept | Prescribed Product Binding: RTPBC Prescribable Product Code Value Set (extensible) |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| coding | SΣI | 1..* | Coding | Code defined by a terminology system |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| system | SΣI | 1..1 | uri | Identity of the terminology system |
| version | ΣI | 0..1 | string | Version of the system - if relevant |
| code | SΣI | 1..1 | code | Symbol in syntax defined by the system |
| display | SΣI | 1..1 | string | Product Description |
| userSelected | ΣI | 0..1 | boolean | If this coding was chosen directly by the user |
| text | ΣI | 0..1 | string | Plain text representation of the concept |
| modifier | I | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example) |
| programCode | I | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) |
| serviced[x] | I | 0..1 | Date or dates of service or product delivery | |
| servicedDate | date | |||
| servicedPeriod | Period | |||
| location[x] | I | 0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example) | |
| locationCodeableConcept | CodeableConcept | |||
| locationAddress | Address | |||
| locationReference | Reference(Location) | |||
| quantity | SI | 1..1 | SimpleQuantity | Prescribed Quantity |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| value | SΣI | 1..1 | decimal | Quantity in Billing Units |
| unit | SΣI | 1..1 | string | Billing unit of measure Binding: RTPBC Billing Unit Value Set (extensible) |
| system | ΣI | 0..1 | uri | System that defines coded unit form |
| code | ΣI | 0..1 | code | Coded form of the unit |
| unitPrice | I | 0..1 | Money | Fee, charge or cost per item |
| factor | I | 0..1 | decimal | Price scaling factor |
| net | I | 0..1 | Money | Total item cost |
| udi | I | 0..* | Reference(Device) | Unique device identifier |
| bodySite | I | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example) |
| subSite | I | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example) |
| encounter | I | 0..* | Reference(Encounter) | Encounters related to this billed item |
| detail | I | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Item instance identifier |
| revenue | I | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | I | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) |
| productOrService | I | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) |
| modifier | I | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example) |
| programCode | I | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) |
| quantity | I | 0..1 | SimpleQuantity | Count of products or services |
| unitPrice | I | 0..1 | Money | Fee, charge or cost per item |
| factor | I | 0..1 | decimal | Price scaling factor |
| net | I | 0..1 | Money | Total item cost |
| udi | I | 0..* | Reference(Device) | Unique device identifier |
| subDetail | I | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Item instance identifier |
| revenue | I | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | I | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) |
| productOrService | I | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) |
| modifier | I | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example) |
| programCode | I | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) |
| quantity | I | 0..1 | SimpleQuantity | Count of products or services |
| unitPrice | I | 0..1 | Money | Fee, charge or cost per item |
| factor | I | 0..1 | decimal | Price scaling factor |
| net | I | 0..1 | Money | Total item cost |
| udi | I | 0..* | Reference(Device) | Unique device identifier |
| total | I | 0..1 | Money | Total claim cost |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | I | 0..* | Claim | Claim, Pre-determination or Pre-authorization |
| id | Σ | 1..1 | string | Unique Claim Resource Identifier |
| identifier | I | 1..1 | Identifier | RTPBC request identifier |
| value | ΣI | 1..1 | string | Unique RTPBC request ID |
| status | ?!ΣI | 1..1 | code | Request status Binding: FinancialResourceStatusCodes (required) Fixed Value: active |
| type | ΣI | 1..1 | CodeableConcept | Requested Service Type Binding: ClaimTypeCodes (extensible) |
| coding | ΣI | 1..1 | Coding | Code defined by a terminology system |
| system | ΣI | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type |
| code | ΣI | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pharmacy |
| display | ΣI | 1..1 | string | Representation defined by the system Fixed Value: Pharmacy |
| use | ΣI | 1..1 | code | Processing Mode Binding: Use (required) Fixed Value: predetermination |
| patient | ΣI | 1..1 | Reference(RTPBC Patient) | Request Patient Information |
| reference | ΣI | 1..1 | string | Patient Reference |
| created | ΣI | 1..1 | dateTime | Created DateTime |
| provider | ΣI | 1..1 | Reference(RTPBC Pharmacy Organization) | Preferred Pharmacy |
| reference | ΣI | 1..1 | string | Reference to Pharmacy Organization |
| priority | ΣI | 1..1 | CodeableConcept | Processing priority Binding: ProcessPriorityCodes (example) |
| coding | ΣI | 1..1 | Coding | Code defined by a terminology system |
| system | ΣI | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority |
| code | ΣI | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal |
| display | ΣI | 1..1 | string | Representation defined by the system Fixed Value: Normal |
| prescription | I | 1..1 | Reference(RTPBC Medication Request) | Prescription Reference |
| reference | ΣI | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| careTeam | I | 1..1 | BackboneElement | Prescriber |
| sequence | I | 1..1 | positiveInt | Order of care team Fixed Value: 1 |
| provider | I | 1..1 | Reference(US Core Practitioner Profile) | Prescriber |
| reference | ΣI | 1..1 | string | Prescriber Reference |
| insurance | ΣI | 1..1 | BackboneElement | Pharmacy Coverage |
| sequence | ΣI | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
| focal | ΣI | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
| coverage | ΣI | 1..1 | Reference(RTPBC Coverage) | Pharmacy Coverage Reference |
| reference | ΣI | 0..1 | string | Pharmacy Coverage Reference |
| item | I | 1..1 | BackboneElement | Max 1 item per request |
| sequence | I | 1..1 | positiveInt | Item instance identifier Fixed Value: 1 |
| careTeamSequence | I | 1..1 | positiveInt | Care Team Sequence ID Reference |
| productOrService | I | 1..1 | CodeableConcept | Prescribed Product Binding: RTPBC Prescribable Product Code Value Set (extensible) |
| coding | ΣI | 1..* | Coding | Code defined by a terminology system |
| system | ΣI | 1..1 | uri | Identity of the terminology system |
| code | ΣI | 1..1 | code | Symbol in syntax defined by the system |
| display | ΣI | 1..1 | string | Product Description |
| quantity | I | 1..1 | SimpleQuantity | Prescribed Quantity |
| value | ΣI | 1..1 | decimal | Quantity in Billing Units |
| unit | ΣI | 1..1 | string | Billing unit of measure Binding: RTPBC Billing Unit Value Set (extensible) |
| Documentation for this format | ||||
This structure is derived from Claim
Summary
Mandatory: 29 elements
Must-Support: 42 elements
Fixed Value: 12 elements
Structures
This structure refers to these other structures:
Differential View
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |
| id | S | 1..1 | string | Unique Claim Resource Identifier |
| identifier | S | 1..1 | Identifier | RTPBC request identifier |
| value | S | 1..1 | string | Unique RTPBC request ID |
| status | S | 1..1 | code | Request status Fixed Value: active |
| type | S | 1..1 | CodeableConcept | Requested Service Type |
| coding | S | 1..1 | Coding | Code defined by a terminology system |
| system | S | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type |
| code | S | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pharmacy |
| display | S | 1..1 | string | Representation defined by the system Fixed Value: Pharmacy |
| use | S | 1..1 | code | Processing Mode Fixed Value: predetermination |
| patient | S | 1..1 | Reference(RTPBC Patient) | Request Patient Information |
| reference | S | 1..1 | string | Patient Reference |
| created | S | 1..1 | dateTime | Created DateTime |
| provider | S | 1..1 | Reference(RTPBC Pharmacy Organization) | Preferred Pharmacy |
| reference | S | 1..1 | string | Reference to Pharmacy Organization |
| priority | S | 1..1 | CodeableConcept | Processing priority |
| coding | S | 1..1 | Coding | Code defined by a terminology system |
| system | S | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority |
| code | S | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal |
| display | S | 1..1 | string | Representation defined by the system Fixed Value: Normal |
| prescription | S | 1..1 | Reference(RTPBC Medication Request) | Prescription Reference |
| reference | S | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| careTeam | S | 1..1 | BackboneElement | Prescriber |
| sequence | S | 1..1 | positiveInt | Order of care team Fixed Value: 1 |
| provider | S | 1..1 | Reference(US Core Practitioner Profile) | Prescriber |
| reference | S | 1..1 | string | Prescriber Reference |
| insurance | S | 1..1 | BackboneElement | Pharmacy Coverage |
| sequence | S | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
| focal | S | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
| coverage | S | 1..1 | Reference(RTPBC Coverage) | Pharmacy Coverage Reference |
| reference | S | 0..1 | string | Pharmacy Coverage Reference |
| item | S | 1..1 | BackboneElement | Max 1 item per request |
| sequence | S | 1..1 | positiveInt | Item instance identifier Fixed Value: 1 |
| careTeamSequence | S | 1..1 | positiveInt | Care Team Sequence ID Reference |
| productOrService | S | 1..1 | CodeableConcept | Prescribed Product Binding: RTPBC Prescribable Product Code Value Set (extensible) |
| coding | S | 1..* | Coding | Code defined by a terminology system |
| system | S | 1..1 | uri | Identity of the terminology system |
| code | S | 1..1 | code | Symbol in syntax defined by the system |
| display | S | 1..1 | string | Product Description |
| quantity | S | 1..1 | SimpleQuantity | Prescribed Quantity |
| value | S | 1..1 | decimal | Quantity in Billing Units |
| unit | S | 1..1 | string | Billing unit of measure Binding: RTPBC Billing Unit Value Set (extensible) |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | I | 0..* | Claim | Claim, Pre-determination or Pre-authorization |
| id | SΣ | 1..1 | string | Unique Claim Resource Identifier |
| meta | ΣI | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!ΣI | 0..1 | uri | A set of rules under which this content was created |
| language | I | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages |
| text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
| contained | 0..* | Resource | Contained, inline Resources | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!I | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SI | 1..1 | Identifier | RTPBC request identifier |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| use | ?!ΣI | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required) |
| type | ΣI | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible) |
| system | ΣI | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | SΣI | 1..1 | string | Unique RTPBC request ID Example General: 123456 |
| period | ΣI | 0..1 | Period | Time period when id is/was valid for use |
| assigner | ΣI | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
| status | ?!SΣI | 1..1 | code | Request status Binding: FinancialResourceStatusCodes (required) Fixed Value: active |
| type | SΣI | 1..1 | CodeableConcept | Requested Service Type Binding: ClaimTypeCodes (extensible) |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| coding | SΣI | 1..1 | Coding | Code defined by a terminology system |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| system | SΣI | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type |
| version | ΣI | 0..1 | string | Version of the system - if relevant |
| code | SΣI | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pharmacy |
| display | SΣI | 1..1 | string | Representation defined by the system Fixed Value: Pharmacy |
| userSelected | ΣI | 0..1 | boolean | If this coding was chosen directly by the user |
| text | ΣI | 0..1 | string | Plain text representation of the concept |
| subType | I | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example) |
| use | SΣI | 1..1 | code | Processing Mode Binding: Use (required) Fixed Value: predetermination |
| patient | SΣI | 1..1 | Reference(RTPBC Patient) | Request Patient Information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 1..1 | string | Patient Reference |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| billablePeriod | ΣI | 0..1 | Period | Relevant time frame for the claim |
| created | SΣI | 1..1 | dateTime | Created DateTime |
| enterer | I | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim |
| insurer | ΣI | 0..1 | Reference(Organization) | Target |
| provider | SΣI | 1..1 | Reference(RTPBC Pharmacy Organization) | Preferred Pharmacy |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 1..1 | string | Reference to Pharmacy Organization |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| priority | SΣI | 1..1 | CodeableConcept | Processing priority Binding: ProcessPriorityCodes (example) |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| coding | SΣI | 1..1 | Coding | Code defined by a terminology system |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| system | SΣI | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority |
| version | ΣI | 0..1 | string | Version of the system - if relevant |
| code | SΣI | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal |
| display | SΣI | 1..1 | string | Representation defined by the system Fixed Value: Normal |
| userSelected | ΣI | 0..1 | boolean | If this coding was chosen directly by the user |
| text | ΣI | 0..1 | string | Plain text representation of the concept |
| fundsReserve | I | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example) |
| related | I | 0..* | BackboneElement | Prior or corollary claims |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| claim | I | 0..1 | Reference(Claim) | Reference to the related claim |
| relationship | I | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example) |
| reference | I | 0..1 | Identifier | File or case reference |
| prescription | SI | 1..1 | Reference(RTPBC Medication Request) | Prescription Reference |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| originalPrescription | I | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller |
| payee | I | 0..1 | BackboneElement | Recipient of benefits payable |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | I | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example) |
| party | I | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference |
| referral | I | 0..1 | Reference(ServiceRequest) | Treatment referral |
| facility | I | 0..1 | Reference(Location) | Servicing facility |
| careTeam | SI | 1..1 | BackboneElement | Prescriber |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | SI | 1..1 | positiveInt | Order of care team Fixed Value: 1 |
| provider | SI | 1..1 | Reference(US Core Practitioner Profile) | Prescriber |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 1..1 | string | Prescriber Reference |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| responsible | I | 0..1 | boolean | Indicator of the lead practitioner |
| role | I | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example) |
| qualification | I | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example) |
| supportingInfo | I | 0..* | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Information instance identifier |
| category | I | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example) |
| code | I | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example) |
| timing[x] | I | 0..1 | When it occurred | |
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | I | 0..1 | Data to be provided | |
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(Resource) | |||
| reason | I | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example) |
| diagnosis | I | 0..* | BackboneElement | Pertinent diagnosis information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Diagnosis instance identifier |
| diagnosis[x] | I | 1..1 | Nature of illness or problem Binding: ICD-10Codes (example) | |
| diagnosisCodeableConcept | CodeableConcept | |||
| diagnosisReference | Reference(Condition) | |||
| type | I | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example) |
| onAdmission | I | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example) |
| packageCode | I | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example) |
| procedure | I | 0..* | BackboneElement | Clinical procedures performed |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Procedure instance identifier |
| type | I | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example) |
| date | I | 0..1 | dateTime | When the procedure was performed |
| procedure[x] | I | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example) | |
| procedureCodeableConcept | CodeableConcept | |||
| procedureReference | Reference(Procedure) | |||
| udi | I | 0..* | Reference(Device) | Unique device identifier |
| insurance | SΣI | 1..1 | BackboneElement | Pharmacy Coverage |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | SΣI | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
| focal | SΣI | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
| identifier | I | 0..1 | Identifier | Pre-assigned Claim number |
| coverage | SΣI | 1..1 | Reference(RTPBC Coverage) | Pharmacy Coverage Reference |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| reference | SΣI | 0..1 | string | Pharmacy Coverage Reference |
| type | ΣI | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible) |
| identifier | ΣI | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | ΣI | 0..1 | string | Text alternative for the resource |
| businessArrangement | I | 0..1 | string | Additional provider contract number |
| preAuthRef | I | 0..* | string | Prior authorization reference number |
| claimResponse | I | 0..1 | Reference(ClaimResponse) | Adjudication results |
| accident | I | 0..1 | BackboneElement | Details of the event |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| date | I | 1..1 | date | When the incident occurred |
| type | I | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible) |
| location[x] | I | 0..1 | Where the event occurred | |
| locationAddress | Address | |||
| locationReference | Reference(Location) | |||
| item | SI | 1..1 | BackboneElement | Max 1 item per request |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | SI | 1..1 | positiveInt | Item instance identifier Fixed Value: 1 |
| careTeamSequence | SI | 1..1 | positiveInt | Care Team Sequence ID Reference |
| diagnosisSequence | I | 0..* | positiveInt | Applicable diagnoses |
| procedureSequence | I | 0..* | positiveInt | Applicable procedures |
| informationSequence | I | 0..* | positiveInt | Applicable exception and supporting information |
| revenue | I | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | I | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) |
| productOrService | SI | 1..1 | CodeableConcept | Prescribed Product Binding: RTPBC Prescribable Product Code Value Set (extensible) |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| coding | SΣI | 1..* | Coding | Code defined by a terminology system |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| system | SΣI | 1..1 | uri | Identity of the terminology system |
| version | ΣI | 0..1 | string | Version of the system - if relevant |
| code | SΣI | 1..1 | code | Symbol in syntax defined by the system |
| display | SΣI | 1..1 | string | Product Description |
| userSelected | ΣI | 0..1 | boolean | If this coding was chosen directly by the user |
| text | ΣI | 0..1 | string | Plain text representation of the concept |
| modifier | I | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example) |
| programCode | I | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) |
| serviced[x] | I | 0..1 | Date or dates of service or product delivery | |
| servicedDate | date | |||
| servicedPeriod | Period | |||
| location[x] | I | 0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example) | |
| locationCodeableConcept | CodeableConcept | |||
| locationAddress | Address | |||
| locationReference | Reference(Location) | |||
| quantity | SI | 1..1 | SimpleQuantity | Prescribed Quantity |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| value | SΣI | 1..1 | decimal | Quantity in Billing Units |
| unit | SΣI | 1..1 | string | Billing unit of measure Binding: RTPBC Billing Unit Value Set (extensible) |
| system | ΣI | 0..1 | uri | System that defines coded unit form |
| code | ΣI | 0..1 | code | Coded form of the unit |
| unitPrice | I | 0..1 | Money | Fee, charge or cost per item |
| factor | I | 0..1 | decimal | Price scaling factor |
| net | I | 0..1 | Money | Total item cost |
| udi | I | 0..* | Reference(Device) | Unique device identifier |
| bodySite | I | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example) |
| subSite | I | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example) |
| encounter | I | 0..* | Reference(Encounter) | Encounters related to this billed item |
| detail | I | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Item instance identifier |
| revenue | I | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | I | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) |
| productOrService | I | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) |
| modifier | I | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example) |
| programCode | I | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) |
| quantity | I | 0..1 | SimpleQuantity | Count of products or services |
| unitPrice | I | 0..1 | Money | Fee, charge or cost per item |
| factor | I | 0..1 | decimal | Price scaling factor |
| net | I | 0..1 | Money | Total item cost |
| udi | I | 0..* | Reference(Device) | Unique device identifier |
| subDetail | I | 0..* | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | I | 0..* | Extension | Additional content defined by implementations |
| modifierExtension | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | I | 1..1 | positiveInt | Item instance identifier |
| revenue | I | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example) |
| category | I | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) |
| productOrService | I | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example) |
| modifier | I | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example) |
| programCode | I | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example) |
| quantity | I | 0..1 | SimpleQuantity | Count of products or services |
| unitPrice | I | 0..1 | Money | Fee, charge or cost per item |
| factor | I | 0..1 | decimal | Price scaling factor |
| net | I | 0..1 | Money | Total item cost |
| udi | I | 0..* | Reference(Device) | Unique device identifier |
| total | I | 0..1 | Money | Total claim cost |
| Documentation for this format | ||||
Other representations of profile: Schematron
| Id | Path | Details | Requirements |
| dom-2 | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | Claim.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.identifier.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.identifier.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.identifier.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.identifier.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.identifier.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.identifier.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.identifier.period | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.identifier.assigner | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.status | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.type.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.type.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.type.coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.type.coding.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.type.coding.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.type.coding.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.type.coding.version | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.type.coding.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.type.coding.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.type.coding.userSelected | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.type.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.subType | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.patient | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.patient.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.patient.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.patient.reference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.patient.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.patient.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.patient.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.billablePeriod | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.created | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.enterer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.provider.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.provider.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.provider.reference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.provider.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.provider.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.provider.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.priority | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.priority.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.priority.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.priority.coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.priority.coding.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.priority.coding.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.priority.coding.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.priority.coding.version | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.priority.coding.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.priority.coding.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.priority.coding.userSelected | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.priority.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.fundsReserve | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.related | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.related.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.related.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.related.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.related.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.related.claim | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.related.relationship | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.related.reference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.prescription | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.prescription.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.prescription.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.prescription.reference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.prescription.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.prescription.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.prescription.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.originalPrescription | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.payee | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.payee.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.payee.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.payee.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.payee.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.payee.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.payee.party | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.referral | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.facility | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.careTeam.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.careTeam.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.careTeam.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.careTeam.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam.provider.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.careTeam.provider.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.careTeam.provider.reference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam.provider.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam.provider.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam.provider.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam.responsible | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam.role | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam.qualification | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.supportingInfo.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.supportingInfo.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.supportingInfo.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.supportingInfo.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo.timing[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo.reason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.diagnosis.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.diagnosis.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.diagnosis.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.diagnosis.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis.diagnosis[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis.onAdmission | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis.packageCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.procedure.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.procedure.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.procedure.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.procedure.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure.date | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure.procedure[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.insurance.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.insurance.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.insurance.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.insurance.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.focal | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.coverage | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.coverage.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.insurance.coverage.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.insurance.coverage.reference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.coverage.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.coverage.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.coverage.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.businessArrangement | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.preAuthRef | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.insurance.claimResponse | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.accident | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.accident.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.accident.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.accident.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.accident.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.accident.date | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.accident.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.accident.location[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.careTeamSequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.diagnosisSequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.procedureSequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.informationSequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.revenue | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.productOrService.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.productOrService.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.productOrService.coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.productOrService.coding.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.productOrService.coding.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.productOrService.coding.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.productOrService.coding.version | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.productOrService.coding.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.productOrService.coding.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.productOrService.coding.userSelected | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.productOrService.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.programCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.serviced[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.location[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.quantity.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.quantity.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.quantity.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.quantity.unit | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.quantity.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.quantity.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.unitPrice | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.factor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.net | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.bodySite | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.subSite | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.encounter | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.detail.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.detail.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.detail.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.detail.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.revenue | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.programCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.unitPrice | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.factor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.net | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.detail.subDetail.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.detail.subDetail.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.detail.subDetail.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.detail.subDetail.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.revenue | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.programCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.unitPrice | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.factor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.net | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.item.detail.subDetail.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.total | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
IG © 2020+ HL7 International - Pharmacy. Package hl7.fhir.us.carin-rtpbc#1.0.0 based on FHIR 4.0.1. Generated 2020-08-25
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