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. For a full list of available versions, see the Directory of published versions

Resource Profile: RtpbcRequestClaim

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…

  • Claim.type = “pharmacy”
  • Claim.provider references an Organization resource that represents the patient’s preferred pharmacy
  • Claim.prescription is mandatory (referencing a MedicationRequest resource)
  • Claim.careTeam.provider is mandatory, referencing a Practitioner resource that identifies the prescriber
  • Claim.item elements are constrained to product identifiers and quantity units of measure describing medications

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.

  • Patient (containing a small amount of identifying information to enable the insurer to locate the patient’s records)
  • Coverage (containing identification of the patient’s pharmacy benefit coverage)
  • MedicationRequest (containing excerpts from the prescription to be priced)
  • Practitioner (identifying the prescriber. Uses US Core Practitioner)
  • Organization (identifying the pharmacy)

Must Support elements in this profile

Client systems

  • Elements that are marked Must Support are essential for the responder to identify the applicable plan rules and accurately determine patient costs and coverage. The submitter MUST ensure that content in these elements is accurate and complete in order to receive reliable information in the response.
  • A reference to a coverage resource MUST be included when submitting to an insurer. It is not required when submitting to a pricing source.

Responding systems

  • MUST make use of all pertinent information provided in the Claim request when determining cost and coverage.

Formal Views of Profile Content

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

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*ClaimClaim, Pre-determination or Pre-authorization
... id S1..1stringUnique Claim Resource Identifier
... identifier S1..1IdentifierRTPBC request identifier
.... value S1..1stringUnique RTPBC request ID
... status S1..1codeRequest status
Fixed Value: active
.... coding S1..1CodingCode defined by a terminology system
..... system S1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code S1..1codeSymbol in syntax defined by the system
Fixed Value: pharmacy
..... display S1..1stringRepresentation defined by the system
Fixed Value: Pharmacy
... use S1..1codeProcessing Mode
Fixed Value: predetermination
... patient S1..1Reference(RTPBC Patient)Request Patient Information
.... reference S1..1stringPatient Reference
... created S1..1dateTimeCreated DateTime
... provider S1..1Reference(RTPBC Pharmacy Organization)Preferred Pharmacy
.... reference S1..1stringReference to Pharmacy Organization
... priority S1..1CodeableConceptProcessing priority
.... coding S1..1CodingCode defined by a terminology system
..... system S1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority
..... code S1..1codeSymbol in syntax defined by the system
Fixed Value: normal
..... display S1..1stringRepresentation defined by the system
Fixed Value: Normal
... prescription S1..1Reference(RTPBC Medication Request)Prescription Reference
.... reference S1..1stringLiteral reference, Relative, internal or absolute URL
... careTeam S1..1BackboneElementPrescriber
.... sequence S1..1positiveIntOrder of care team
Fixed Value: 1
.... provider S1..1Reference(US Core Practitioner Profile)Prescriber
..... reference S1..1stringPrescriber Reference
... insurance S1..1BackboneElementPharmacy Coverage
.... sequence S1..1positiveIntInsurance instance identifier
Fixed Value: 1
.... focal S1..1booleanCoverage to be used for adjudication
Fixed Value: true
.... coverage S1..1Reference(RTPBC Coverage)Pharmacy Coverage Reference
..... reference S0..1stringPharmacy Coverage Reference
... item S1..1BackboneElementMax 1 item per request
.... sequence S1..1positiveIntItem instance identifier
Fixed Value: 1
.... careTeamSequence S1..1positiveIntCare Team Sequence ID Reference
.... productOrService S1..1CodeableConceptPrescribed Product
Binding: RTPBC Prescribable Product Code Value Set (extensible)
..... coding S1..*CodingCode defined by a terminology system
...... system S1..1uriIdentity of the terminology system
...... code S1..1codeSymbol in syntax defined by the system
...... display S1..1stringProduct Description
.... quantity S1..1SimpleQuantityPrescribed Quantity
..... value S1..1decimalQuantity in Billing Units
..... unit S1..1stringBilling unit of measure
Binding: RTPBC Billing Unit Value Set (extensible)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim I0..*ClaimClaim, Pre-determination or Pre-authorization
... id SΣ1..1stringUnique Claim Resource Identifier
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier SI1..1IdentifierRTPBC request identifier
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type ΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system ΣI0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣI1..1stringUnique RTPBC request ID
Example General: 123456
.... period ΣI0..1PeriodTime period when id is/was valid for use
.... assigner ΣI0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣI1..1codeRequest status
Binding: FinancialResourceStatusCodes (required)
Fixed Value: active
... type SΣI1..1CodeableConceptRequested Service Type
Binding: ClaimTypeCodes (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣI1..1CodingCode defined by a terminology system
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣI1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version ΣI0..1stringVersion of the system - if relevant
..... code SΣI1..1codeSymbol in syntax defined by the system
Fixed Value: pharmacy
..... display SΣI1..1stringRepresentation defined by the system
Fixed Value: Pharmacy
..... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
.... text ΣI0..1stringPlain text representation of the concept
... subType I0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example)
... use SΣI1..1codeProcessing Mode
Binding: Use (required)
Fixed Value: predetermination
... patient SΣI1..1Reference(RTPBC Patient)Request Patient Information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringPatient Reference
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... billablePeriod ΣI0..1PeriodRelevant time frame for the claim
... created SΣI1..1dateTimeCreated DateTime
... enterer I0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer ΣI0..1Reference(Organization)Target
... provider SΣI1..1Reference(RTPBC Pharmacy Organization)Preferred Pharmacy
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringReference to Pharmacy Organization
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... priority SΣI1..1CodeableConceptProcessing priority
Binding: ProcessPriorityCodes (example)
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣI1..1CodingCode defined by a terminology system
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣI1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority
..... version ΣI0..1stringVersion of the system - if relevant
..... code SΣI1..1codeSymbol in syntax defined by the system
Fixed Value: normal
..... display SΣI1..1stringRepresentation defined by the system
Fixed Value: Normal
..... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
.... text ΣI0..1stringPlain text representation of the concept
... fundsReserve I0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example)
... related I0..*BackboneElementPrior or corollary claims
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim I0..1Reference(Claim)Reference to the related claim
.... relationship I0..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example)
.... reference I0..1IdentifierFile or case reference
... prescription SI1..1Reference(RTPBC Medication Request)Prescription Reference
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringLiteral reference, Relative, internal or absolute URL
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... originalPrescription I0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee I0..1BackboneElementRecipient of benefits payable
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type I1..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example)
.... party I0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral I0..1Reference(ServiceRequest)Treatment referral
... facility I0..1Reference(Location)Servicing facility
... careTeam SI1..1BackboneElementPrescriber
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence SI1..1positiveIntOrder of care team
Fixed Value: 1
.... provider SI1..1Reference(US Core Practitioner Profile)Prescriber
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... reference SΣI1..1stringPrescriber Reference
..... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
..... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
..... display ΣI0..1stringText alternative for the resource
.... responsible I0..1booleanIndicator of the lead practitioner
.... role I0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example)
.... qualification I0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo I0..*BackboneElementSupporting information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntInformation instance identifier
.... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
.... code I0..1CodeableConceptType of information
Binding: ExceptionCodes (example)
.... timing[x] I0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] I0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason I0..1CodeableConceptExplanation for the information
Binding: MissingToothReasonCodes (example)
... diagnosis I0..*BackboneElementPertinent diagnosis information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] I1..1Nature of illness or problem
Binding: ICD-10Codes (example)
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type I0..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example)
.... onAdmission I0..1CodeableConceptPresent on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example)
.... packageCode I0..1CodeableConceptPackage billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
... procedure I0..*BackboneElementClinical procedures performed
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntProcedure instance identifier
.... type I0..*CodeableConceptCategory of Procedure
Binding: ExampleProcedureTypeCodes (example)
.... date I0..1dateTimeWhen the procedure was performed
.... procedure[x] I1..1Specific clinical procedure
Binding: ICD-10ProcedureCodes (example)
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi I0..*Reference(Device)Unique device identifier
... insurance SΣI1..1BackboneElementPharmacy Coverage
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence SΣI1..1positiveIntInsurance instance identifier
Fixed Value: 1
.... focal SΣI1..1booleanCoverage to be used for adjudication
Fixed Value: true
.... identifier I0..1IdentifierPre-assigned Claim number
.... coverage SΣI1..1Reference(RTPBC Coverage)Pharmacy Coverage Reference
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... reference SΣI0..1stringPharmacy Coverage Reference
..... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
..... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
..... display ΣI0..1stringText alternative for the resource
.... businessArrangement I0..1stringAdditional provider contract number
.... preAuthRef I0..*stringPrior authorization reference number
.... claimResponse I0..1Reference(ClaimResponse)Adjudication results
... accident I0..1BackboneElementDetails of the event
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date I1..1dateWhen the incident occurred
.... type I0..1CodeableConceptThe nature of the accident
Binding: ActIncidentCode (extensible)
.... location[x] I0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item SI1..1BackboneElementMax 1 item per request
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence SI1..1positiveIntItem instance identifier
Fixed Value: 1
.... careTeamSequence SI1..1positiveIntCare Team Sequence ID Reference
.... diagnosisSequence I0..*positiveIntApplicable diagnoses
.... procedureSequence I0..*positiveIntApplicable procedures
.... informationSequence I0..*positiveIntApplicable exception and supporting information
.... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
.... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
.... productOrService SI1..1CodeableConceptPrescribed Product
Binding: RTPBC Prescribable Product Code Value Set (extensible)
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣI1..*CodingCode defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣI1..1uriIdentity of the terminology system
...... version ΣI0..1stringVersion of the system - if relevant
...... code SΣI1..1codeSymbol in syntax defined by the system
...... display SΣI1..1stringProduct Description
...... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
..... text ΣI0..1stringPlain text representation of the concept
.... modifier I0..*CodeableConceptProduct or service billing modifiers
Binding: ModifierTypeCodes (example)
.... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
.... serviced[x] I0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] I0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity SI1..1SimpleQuantityPrescribed Quantity
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣI1..1decimalQuantity in Billing Units
..... unit SΣI1..1stringBilling unit of measure
Binding: RTPBC Billing Unit Value Set (extensible)
..... system ΣI0..1uriSystem that defines coded unit form
..... code ΣI0..1codeCoded form of the unit
.... unitPrice I0..1MoneyFee, charge or cost per item
.... factor I0..1decimalPrice scaling factor
.... net I0..1MoneyTotal item cost
.... udi I0..*Reference(Device)Unique device identifier
.... bodySite I0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example)
.... subSite I0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example)
.... encounter I0..*Reference(Encounter)Encounters related to this billed item
.... detail I0..*BackboneElementProduct or service provided
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntItem instance identifier
..... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
..... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
..... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
..... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
..... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
..... quantity I0..1SimpleQuantityCount of products or services
..... unitPrice I0..1MoneyFee, charge or cost per item
..... factor I0..1decimalPrice scaling factor
..... net I0..1MoneyTotal item cost
..... udi I0..*Reference(Device)Unique device identifier
..... subDetail I0..*BackboneElementProduct or service provided
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence I1..1positiveIntItem instance identifier
...... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
...... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
...... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
...... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
...... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
...... quantity I0..1SimpleQuantityCount of products or services
...... unitPrice I0..1MoneyFee, charge or cost per item
...... factor I0..1decimalPrice scaling factor
...... net I0..1MoneyTotal item cost
...... udi I0..*Reference(Device)Unique device identifier
... total I0..1MoneyTotal claim cost

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim I0..*ClaimClaim, Pre-determination or Pre-authorization
... id Σ1..1stringUnique Claim Resource Identifier
... identifier I1..1IdentifierRTPBC request identifier
.... value ΣI1..1stringUnique RTPBC request ID
... status ?!ΣI1..1codeRequest status
Binding: FinancialResourceStatusCodes (required)
Fixed Value: active
.... coding ΣI1..1CodingCode defined by a terminology system
..... system ΣI1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code ΣI1..1codeSymbol in syntax defined by the system
Fixed Value: pharmacy
..... display ΣI1..1stringRepresentation defined by the system
Fixed Value: Pharmacy
... use ΣI1..1codeProcessing Mode
Binding: Use (required)
Fixed Value: predetermination
... patient ΣI1..1Reference(RTPBC Patient)Request Patient Information
.... reference ΣI1..1stringPatient Reference
... created ΣI1..1dateTimeCreated DateTime
... provider ΣI1..1Reference(RTPBC Pharmacy Organization)Preferred Pharmacy
.... reference ΣI1..1stringReference to Pharmacy Organization
... priority ΣI1..1CodeableConceptProcessing priority
Binding: ProcessPriorityCodes (example)
.... coding ΣI1..1CodingCode defined by a terminology system
..... system ΣI1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority
..... code ΣI1..1codeSymbol in syntax defined by the system
Fixed Value: normal
..... display ΣI1..1stringRepresentation defined by the system
Fixed Value: Normal
... prescription I1..1Reference(RTPBC Medication Request)Prescription Reference
.... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
... careTeam I1..1BackboneElementPrescriber
.... sequence I1..1positiveIntOrder of care team
Fixed Value: 1
.... provider I1..1Reference(US Core Practitioner Profile)Prescriber
..... reference ΣI1..1stringPrescriber Reference
... insurance ΣI1..1BackboneElementPharmacy Coverage
.... sequence ΣI1..1positiveIntInsurance instance identifier
Fixed Value: 1
.... focal ΣI1..1booleanCoverage to be used for adjudication
Fixed Value: true
.... coverage ΣI1..1Reference(RTPBC Coverage)Pharmacy Coverage Reference
..... reference ΣI0..1stringPharmacy Coverage Reference
... item I1..1BackboneElementMax 1 item per request
.... sequence I1..1positiveIntItem instance identifier
Fixed Value: 1
.... careTeamSequence I1..1positiveIntCare Team Sequence ID Reference
.... productOrService I1..1CodeableConceptPrescribed Product
Binding: RTPBC Prescribable Product Code Value Set (extensible)
..... coding ΣI1..*CodingCode defined by a terminology system
...... system ΣI1..1uriIdentity of the terminology system
...... code ΣI1..1codeSymbol in syntax defined by the system
...... display ΣI1..1stringProduct Description
.... quantity I1..1SimpleQuantityPrescribed Quantity
..... value ΣI1..1decimalQuantity in Billing Units
..... unit ΣI1..1stringBilling unit of measure
Binding: RTPBC Billing Unit Value Set (extensible)

doco Documentation for this format

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*ClaimClaim, Pre-determination or Pre-authorization
... id S1..1stringUnique Claim Resource Identifier
... identifier S1..1IdentifierRTPBC request identifier
.... value S1..1stringUnique RTPBC request ID
... status S1..1codeRequest status
Fixed Value: active
.... coding S1..1CodingCode defined by a terminology system
..... system S1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code S1..1codeSymbol in syntax defined by the system
Fixed Value: pharmacy
..... display S1..1stringRepresentation defined by the system
Fixed Value: Pharmacy
... use S1..1codeProcessing Mode
Fixed Value: predetermination
... patient S1..1Reference(RTPBC Patient)Request Patient Information
.... reference S1..1stringPatient Reference
... created S1..1dateTimeCreated DateTime
... provider S1..1Reference(RTPBC Pharmacy Organization)Preferred Pharmacy
.... reference S1..1stringReference to Pharmacy Organization
... priority S1..1CodeableConceptProcessing priority
.... coding S1..1CodingCode defined by a terminology system
..... system S1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority
..... code S1..1codeSymbol in syntax defined by the system
Fixed Value: normal
..... display S1..1stringRepresentation defined by the system
Fixed Value: Normal
... prescription S1..1Reference(RTPBC Medication Request)Prescription Reference
.... reference S1..1stringLiteral reference, Relative, internal or absolute URL
... careTeam S1..1BackboneElementPrescriber
.... sequence S1..1positiveIntOrder of care team
Fixed Value: 1
.... provider S1..1Reference(US Core Practitioner Profile)Prescriber
..... reference S1..1stringPrescriber Reference
... insurance S1..1BackboneElementPharmacy Coverage
.... sequence S1..1positiveIntInsurance instance identifier
Fixed Value: 1
.... focal S1..1booleanCoverage to be used for adjudication
Fixed Value: true
.... coverage S1..1Reference(RTPBC Coverage)Pharmacy Coverage Reference
..... reference S0..1stringPharmacy Coverage Reference
... item S1..1BackboneElementMax 1 item per request
.... sequence S1..1positiveIntItem instance identifier
Fixed Value: 1
.... careTeamSequence S1..1positiveIntCare Team Sequence ID Reference
.... productOrService S1..1CodeableConceptPrescribed Product
Binding: RTPBC Prescribable Product Code Value Set (extensible)
..... coding S1..*CodingCode defined by a terminology system
...... system S1..1uriIdentity of the terminology system
...... code S1..1codeSymbol in syntax defined by the system
...... display S1..1stringProduct Description
.... quantity S1..1SimpleQuantityPrescribed Quantity
..... value S1..1decimalQuantity in Billing Units
..... unit S1..1stringBilling unit of measure
Binding: RTPBC Billing Unit Value Set (extensible)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim I0..*ClaimClaim, Pre-determination or Pre-authorization
... id SΣ1..1stringUnique Claim Resource Identifier
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier SI1..1IdentifierRTPBC request identifier
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!ΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
.... type ΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... system ΣI0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣI1..1stringUnique RTPBC request ID
Example General: 123456
.... period ΣI0..1PeriodTime period when id is/was valid for use
.... assigner ΣI0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣI1..1codeRequest status
Binding: FinancialResourceStatusCodes (required)
Fixed Value: active
... type SΣI1..1CodeableConceptRequested Service Type
Binding: ClaimTypeCodes (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣI1..1CodingCode defined by a terminology system
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣI1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version ΣI0..1stringVersion of the system - if relevant
..... code SΣI1..1codeSymbol in syntax defined by the system
Fixed Value: pharmacy
..... display SΣI1..1stringRepresentation defined by the system
Fixed Value: Pharmacy
..... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
.... text ΣI0..1stringPlain text representation of the concept
... subType I0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example)
... use SΣI1..1codeProcessing Mode
Binding: Use (required)
Fixed Value: predetermination
... patient SΣI1..1Reference(RTPBC Patient)Request Patient Information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringPatient Reference
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... billablePeriod ΣI0..1PeriodRelevant time frame for the claim
... created SΣI1..1dateTimeCreated DateTime
... enterer I0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer ΣI0..1Reference(Organization)Target
... provider SΣI1..1Reference(RTPBC Pharmacy Organization)Preferred Pharmacy
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringReference to Pharmacy Organization
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... priority SΣI1..1CodeableConceptProcessing priority
Binding: ProcessPriorityCodes (example)
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣI1..1CodingCode defined by a terminology system
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣI1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority
..... version ΣI0..1stringVersion of the system - if relevant
..... code SΣI1..1codeSymbol in syntax defined by the system
Fixed Value: normal
..... display SΣI1..1stringRepresentation defined by the system
Fixed Value: Normal
..... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
.... text ΣI0..1stringPlain text representation of the concept
... fundsReserve I0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example)
... related I0..*BackboneElementPrior or corollary claims
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim I0..1Reference(Claim)Reference to the related claim
.... relationship I0..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example)
.... reference I0..1IdentifierFile or case reference
... prescription SI1..1Reference(RTPBC Medication Request)Prescription Reference
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣI1..1stringLiteral reference, Relative, internal or absolute URL
.... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
.... display ΣI0..1stringText alternative for the resource
... originalPrescription I0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee I0..1BackboneElementRecipient of benefits payable
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type I1..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example)
.... party I0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral I0..1Reference(ServiceRequest)Treatment referral
... facility I0..1Reference(Location)Servicing facility
... careTeam SI1..1BackboneElementPrescriber
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence SI1..1positiveIntOrder of care team
Fixed Value: 1
.... provider SI1..1Reference(US Core Practitioner Profile)Prescriber
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... reference SΣI1..1stringPrescriber Reference
..... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
..... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
..... display ΣI0..1stringText alternative for the resource
.... responsible I0..1booleanIndicator of the lead practitioner
.... role I0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example)
.... qualification I0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo I0..*BackboneElementSupporting information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntInformation instance identifier
.... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
.... code I0..1CodeableConceptType of information
Binding: ExceptionCodes (example)
.... timing[x] I0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] I0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason I0..1CodeableConceptExplanation for the information
Binding: MissingToothReasonCodes (example)
... diagnosis I0..*BackboneElementPertinent diagnosis information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] I1..1Nature of illness or problem
Binding: ICD-10Codes (example)
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type I0..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example)
.... onAdmission I0..1CodeableConceptPresent on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example)
.... packageCode I0..1CodeableConceptPackage billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
... procedure I0..*BackboneElementClinical procedures performed
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntProcedure instance identifier
.... type I0..*CodeableConceptCategory of Procedure
Binding: ExampleProcedureTypeCodes (example)
.... date I0..1dateTimeWhen the procedure was performed
.... procedure[x] I1..1Specific clinical procedure
Binding: ICD-10ProcedureCodes (example)
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi I0..*Reference(Device)Unique device identifier
... insurance SΣI1..1BackboneElementPharmacy Coverage
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence SΣI1..1positiveIntInsurance instance identifier
Fixed Value: 1
.... focal SΣI1..1booleanCoverage to be used for adjudication
Fixed Value: true
.... identifier I0..1IdentifierPre-assigned Claim number
.... coverage SΣI1..1Reference(RTPBC Coverage)Pharmacy Coverage Reference
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... reference SΣI0..1stringPharmacy Coverage Reference
..... type ΣI0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
..... identifier ΣI0..1IdentifierLogical reference, when literal reference is not known
..... display ΣI0..1stringText alternative for the resource
.... businessArrangement I0..1stringAdditional provider contract number
.... preAuthRef I0..*stringPrior authorization reference number
.... claimResponse I0..1Reference(ClaimResponse)Adjudication results
... accident I0..1BackboneElementDetails of the event
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date I1..1dateWhen the incident occurred
.... type I0..1CodeableConceptThe nature of the accident
Binding: ActIncidentCode (extensible)
.... location[x] I0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item SI1..1BackboneElementMax 1 item per request
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence SI1..1positiveIntItem instance identifier
Fixed Value: 1
.... careTeamSequence SI1..1positiveIntCare Team Sequence ID Reference
.... diagnosisSequence I0..*positiveIntApplicable diagnoses
.... procedureSequence I0..*positiveIntApplicable procedures
.... informationSequence I0..*positiveIntApplicable exception and supporting information
.... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
.... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
.... productOrService SI1..1CodeableConceptPrescribed Product
Binding: RTPBC Prescribable Product Code Value Set (extensible)
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣI1..*CodingCode defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣI1..1uriIdentity of the terminology system
...... version ΣI0..1stringVersion of the system - if relevant
...... code SΣI1..1codeSymbol in syntax defined by the system
...... display SΣI1..1stringProduct Description
...... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
..... text ΣI0..1stringPlain text representation of the concept
.... modifier I0..*CodeableConceptProduct or service billing modifiers
Binding: ModifierTypeCodes (example)
.... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
.... serviced[x] I0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] I0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity SI1..1SimpleQuantityPrescribed Quantity
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣI1..1decimalQuantity in Billing Units
..... unit SΣI1..1stringBilling unit of measure
Binding: RTPBC Billing Unit Value Set (extensible)
..... system ΣI0..1uriSystem that defines coded unit form
..... code ΣI0..1codeCoded form of the unit
.... unitPrice I0..1MoneyFee, charge or cost per item
.... factor I0..1decimalPrice scaling factor
.... net I0..1MoneyTotal item cost
.... udi I0..*Reference(Device)Unique device identifier
.... bodySite I0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example)
.... subSite I0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example)
.... encounter I0..*Reference(Encounter)Encounters related to this billed item
.... detail I0..*BackboneElementProduct or service provided
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntItem instance identifier
..... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
..... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
..... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
..... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
..... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
..... quantity I0..1SimpleQuantityCount of products or services
..... unitPrice I0..1MoneyFee, charge or cost per item
..... factor I0..1decimalPrice scaling factor
..... net I0..1MoneyTotal item cost
..... udi I0..*Reference(Device)Unique device identifier
..... subDetail I0..*BackboneElementProduct or service provided
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence I1..1positiveIntItem instance identifier
...... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
...... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
...... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
...... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
...... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
...... quantity I0..1SimpleQuantityCount of products or services
...... unitPrice I0..1MoneyFee, charge or cost per item
...... factor I0..1decimalPrice scaling factor
...... net I0..1MoneyTotal item cost
...... udi I0..*Reference(Device)Unique device identifier
... total I0..1MoneyTotal claim cost

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet / Code
Claim.languagepreferredCommonLanguages
Max Binding: AllLanguages
Claim.identifier.userequiredIdentifierUse
Claim.identifier.typeextensibleIdentifier Type Codes
Claim.statusrequiredFixed Value: active
Claim.typeextensibleClaimTypeCodes
Claim.subTypeexampleExampleClaimSubTypeCodes
Claim.userequiredFixed Value: predetermination
Claim.patient.typeextensibleResourceType
Claim.provider.typeextensibleResourceType
Claim.priorityexampleProcessPriorityCodes
Claim.fundsReserveexampleFunds Reservation Codes
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
Claim.prescription.typeextensibleResourceType
Claim.payee.typeexampleClaim Payee Type Codes
Claim.careTeam.provider.typeextensibleResourceType
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
Claim.supportingInfo.codeexampleExceptionCodes
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
Claim.procedure.typeexampleExampleProcedureTypeCodes
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
Claim.insurance.coverage.typeextensibleResourceType
Claim.accident.typeextensibleActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
Claim.item.categoryexampleBenefitCategoryCodes
Claim.item.productOrServiceextensibleRTPBCPrescribableProductCodeValueSet
Claim.item.modifierexampleModifierTypeCodes
Claim.item.programCodeexampleExampleProgramReasonCodes
Claim.item.location[x]exampleExampleServicePlaceCodes
Claim.item.quantity.unitextensibleRtbpcBillingUnitValueSet
Claim.item.bodySiteexampleOralSiteCodes
Claim.item.subSiteexampleSurfaceCodes
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
Claim.item.detail.categoryexampleBenefitCategoryCodes
Claim.item.detail.productOrServiceexampleUSCLSCodes
Claim.item.detail.modifierexampleModifierTypeCodes
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes

Constraints

IdPathDetailsRequirements
dom-2ClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3ClaimIf 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-4ClaimIf 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-5ClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6ClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1Claim.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.identifier.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.identifier.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.identifier.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.identifier.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.identifier.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.identifier.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.identifier.periodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.identifier.assignerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.type.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.type.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.type.codingAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.type.coding.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.type.coding.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.type.coding.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.type.coding.versionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.type.coding.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.type.coding.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.type.coding.userSelectedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.type.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.subTypeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.patientAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.patient.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.patient.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.patient.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.patient.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.patient.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.patient.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.billablePeriodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.createdAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.entererAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.provider.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.provider.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.provider.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.provider.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.provider.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.provider.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priorityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priority.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.priority.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.priority.codingAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priority.coding.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.priority.coding.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.priority.coding.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priority.coding.versionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priority.coding.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priority.coding.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priority.coding.userSelectedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priority.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.fundsReserveAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.relatedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.related.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.related.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.related.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.related.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.related.claimAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.related.relationshipAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.related.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.prescriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.prescription.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.prescription.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.prescription.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.prescription.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.prescription.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.prescription.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.originalPrescriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.payeeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.payee.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.payee.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.payee.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.payee.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.payee.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.payee.partyAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.referralAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.facilityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeamAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.careTeam.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.careTeam.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.careTeam.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.careTeam.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.provider.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.careTeam.provider.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.careTeam.provider.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.provider.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.provider.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.provider.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.responsibleAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.roleAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.qualificationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfoAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.supportingInfo.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.supportingInfo.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.supportingInfo.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.supportingInfo.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.timing[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.reasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosisAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.diagnosis.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.diagnosis.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.diagnosis.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.diagnosis.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.diagnosis[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.onAdmissionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.packageCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedureAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.procedure.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.procedure.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.procedure.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.procedure.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.procedure[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insuranceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.insurance.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.insurance.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.insurance.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.insurance.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.focalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.coverageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.coverage.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.insurance.coverage.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.insurance.coverage.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.coverage.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.coverage.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.coverage.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.businessArrangementAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.preAuthRefAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.claimResponseAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accidentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accident.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.accident.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.accident.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.accident.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.accident.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accident.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accident.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.itemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.careTeamSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.diagnosisSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.procedureSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.informationSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrService.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.productOrService.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.productOrService.codingAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrService.coding.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.productOrService.coding.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.productOrService.coding.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrService.coding.versionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrService.coding.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrService.coding.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrService.coding.userSelectedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrService.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.serviced[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.quantity.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.quantity.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.quantity.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.quantity.unitAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.quantity.systemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.quantity.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.bodySiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.subSiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.encounterAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.subDetail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.subDetail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.subDetail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.subDetail.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.totalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())