Patient Cost Transparency Implementation Guide
0.1.0 - STU 1 Ballot
Patient Cost Transparency Implementation Guide
0.1.0 - STU 1 Ballot
This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v0.1.0: STU 1 Draft) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions
| Defining URL: | http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional |
| Version: | 0.1.0 |
| Name: | PCTGFEProfessional |
| Title: | PCT Good Faith Estimate Professional |
| Status: | Active as of 12/4/21 9:54 PM |
| Definition: | PCT Good Faith Estimate Professional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for a professional GFE submission. |
| Publisher: | HL7 International - Financial Management Work Group |
| Source Resource: | XML / JSON / Turtle |
The official URL for this profile is:
http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Claim
Summary
Mandatory: 12 elements (8 nested mandatory elements)
Must-Support: 47 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |
  Slices for extension | 2..* | Extension | Extension Slice: Unordered, Open by value:url | |
 gfeSubmitter | S | 1..1 | Reference(PCT Organization | PCT Practitioner) | The scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeSubmitter |
| gfeProviderAssignedIdentifier | S | 1..1 | Identifier | GFE Provider Assigned Identifier URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeProviderAssignedIdentifier |
| gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo |
| providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology |
| interTransIdentifier | S | 0..1 | Identifier | Intermediary Transmission Identifier URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/interTransIdentifier |
  type | 1..1 | CodeableConcept | Category or discipline Required Pattern: At least the following | |
   coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
 system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | |
 display | 1..1 | string | Representation defined by the system Fixed Value: Professional | |
| use | 1..1 | code | claim | preauthorization | predetermination Required Pattern: predetermination | |
 patient | S | 1..1 | Reference(PCT Patient) | The recipient of the products and services |
| insurer | 1..1 | Reference(PCT Organization) | Target | |
| provider | 1..1 | Reference(PCT Organization | PCT PractitionerRole) | Billing provider - party responsible for the GFE | |
| priority | S | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required) |
| payee | S | 0..1 | BackboneElement | Recipient of benefits payable |
| party | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |
| referral | ||||
| extension | 1..* | Extension | Extension | |
| referralNumber | S | 1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| facility | S | 0..1 | Reference(PCT Location) | Servicing facility |
 Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role |
 careTeam:All Slices | Content/Rules for all slices | |||
  provider | S | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization |
| role | S | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
 qualification | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required) |
| careTeam:rendering | S | 0..2 | BackboneElement | Members of the care team |
 role | 0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
 coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering | |
 qualification | 1..1 | CodeableConcept | Practitioner credential or specialization - must provide a taxonomy code for the Professional case | |
 careTeam:referring | S | 0..1 | BackboneElement | Members of the care team |
 role | 0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring | |
| Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category |
| supportingInfo:All Slices | Content/Rules for all slices | |||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (extensible) | |
| supportingInfo:placeOfService | S | 0..1 | BackboneElement | Supporting information |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: cmspos | |
| display | 1..1 | string | Representation defined by the system Fixed Value: CMS Place of Service | |
| code | S | 1..1 | CodeableConcept | Type of information Binding: PCT GFE CMS Place of Service Value Set (required) |
| Slices for diagnosis | S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type |
| diagnosis:All Slices | Content/Rules for all slices | |||
| type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: PCT Diagnosis Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| diagnosis:principal | S | 1..1 | BackboneElement | Pertinent diagnosis information |
 sequence | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1 | |
 diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) |
| type | 1..* | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal | |
| packageCode | S | 0..1 | CodeableConcept | For the Professional case this is the Provider GFE Grouper Methodology |
| diagnosis:other | S | 0..11 | BackboneElement | Pertinent diagnosis information |
| diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) |
| type | 1..* | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| packageCode | S | 0..1 | CodeableConcept | For the Professional case this is the Provider GFE Grouper Methodology |
| Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type |
| procedure:All Slices | Content/Rules for all slices | |||
| type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed |
| type | 1..* | CodeableConcept | Category of Procedure Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia | |
| procedure[x] | S | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) |
| procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed |
| type | 1..* | CodeableConcept | Category of Procedure Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| procedure[x] | S | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) |
| insurance | ||||
| coverage | S | 1..1 | Reference(PCT Coverage) | Insurance information |
| preAuthRef | S | 0..2 | string | Prior authorization reference number |
| item | S | 1..50 | BackboneElement | Product or service provided |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| referralNumber | S | 0..11 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| estimatedDateOfService | S | 0..1 | date, Period | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService |
| gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item CPT - HCPCS Value Set (required) | |
| modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required) |
| Slices for location[x] | 1..1 | CodeableConcept | Place of service or where product was supplied Slice: Unordered, Open by type:$this | |
| locationCodeableConcept | S | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required) |
| quantity | S | 1..1 | SimpleQuantity | Count of products or services |
| net | S | 1..1 | Money | Total item cost |
| detail | S | 0..* | BackboneElement | Drug Identification Information |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| compoundDrugLinkingNum | S | 0..1 | id, integer | Compound Drug Linking Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/compoundDrugLinkingNum |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required) | |
| quantity | S | 0..1 | SimpleQuantity | Count of products or services |
| total | 1..1 | Money | Total GFE Charges Submitted | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |
 id | Σ | 0..1 | string | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| Slices for extension | 2..* | Extension | Extension Slice: Unordered, Open by value:url | |
| gfeSubmitter | S | 1..1 | Reference(PCT Organization | PCT Practitioner) | The scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeSubmitter |
| gfeProviderAssignedIdentifier | S | 1..1 | Identifier | GFE Provider Assigned Identifier URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeProviderAssignedIdentifier |
| gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo |
| providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology |
| interTransIdentifier | S | 0..1 | Identifier | Intermediary Transmission Identifier URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/interTransIdentifier |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | 0..* | Identifier | Business Identifier for claim | |
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
| type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Professional | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| subType | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |
| use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination |
| patient | SΣ | 1..1 | Reference(PCT Patient) | The recipient of the products and services |
| billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim |
| created | Σ | 1..1 | dateTime | Resource creation date |
| enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |
| insurer | Σ | 1..1 | Reference(PCT Organization) | Target |
| provider | Σ | 1..1 | Reference(PCT Organization | PCT PractitionerRole) | Billing provider - party responsible for the GFE |
| priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required) |
| fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |
| related | 0..* | BackboneElement | Prior or corollary claims | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| claim | 0..1 | Reference(Claim) | Reference to the related claim | |
| relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |
| reference | 0..1 | Identifier | File or case reference | |
| prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |
| originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |
| payee | S | 0..1 | BackboneElement | Recipient of benefits payable |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |
| party | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |
| referral | 0..1 | Reference(ServiceRequest) | Treatment referral | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| referralNumber | S | 1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| reference | ΣI | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). |
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | Σ | 0..1 | string | Text alternative for the resource |
| facility | S | 0..1 | Reference(PCT Location) | Servicing facility |
| Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role |
| careTeam:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Order of care team | |
| provider | S | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization |
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |
| role | S | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| qualification | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required) |
| careTeam:rendering | S | 0..2 | BackboneElement | Members of the care team |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Order of care team | |
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |
| role | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| qualification | 1..1 | CodeableConcept | Practitioner credential or specialization - must provide a taxonomy code for the Professional case Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |
| careTeam:referring | S | 0..1 | BackboneElement | Members of the care team |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Order of care team | |
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |
| role | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |
| Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category |
| supportingInfo:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Information instance identifier | |
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (extensible) | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |
 timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(Resource) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |
| supportingInfo:placeOfService | S | 0..1 | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Information instance identifier | |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: cmspos | |
| display | 1..1 | string | Representation defined by the system Fixed Value: CMS Place of Service | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | S | 1..1 | CodeableConcept | Type of information Binding: PCT GFE CMS Place of Service Value Set (required) |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(Resource) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |
| Slices for diagnosis | S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type |
| diagnosis:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | |
| diagnosis[x] | 1..1 | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||
| diagnosisCodeableConcept | CodeableConcept | |||
| diagnosisReference | Reference(Condition) | |||
| type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: PCT Diagnosis Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |
| diagnosis:principal | S | 1..1 | BackboneElement | Pertinent diagnosis information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1 | |
| diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) |
| type | 1..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |
| packageCode | S | 0..1 | CodeableConcept | For the Professional case this is the Provider GFE Grouper Methodology Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. |
| diagnosis:other | S | 0..11 | BackboneElement | Pertinent diagnosis information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | |
| diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) |
| type | 1..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |
| packageCode | S | 0..1 | CodeableConcept | For the Professional case this is the Provider GFE Grouper Methodology Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. |
| Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type |
| procedure:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Procedure instance identifier | |
| type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| date | 0..1 | dateTime | When the procedure was performed | |
| procedure[x] | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||
| procedureCodeableConcept | CodeableConcept | |||
| procedureReference | Reference(Procedure) | |||
| udi | 0..* | Reference(Device) | Unique device identifier | |
| procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Procedure instance identifier | |
| type | 1..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| date | 0..1 | dateTime | When the procedure was performed | |
| procedure[x] | S | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Procedure instance identifier | |
| type | 1..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| date | 0..1 | dateTime | When the procedure was performed | |
| procedure[x] | S | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| insurance | Σ | 1..* | BackboneElement | Patient insurance information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier |
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication |
| identifier | 0..1 | Identifier | Pre-assigned Claim number | |
| coverage | SΣ | 1..1 | Reference(PCT Coverage) | Insurance information |
| businessArrangement | 0..1 | string | Additional provider contract number | |
| preAuthRef | S | 0..2 | string | Prior authorization reference number |
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |
| accident | 0..1 | BackboneElement | Details of the event | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| date | 1..1 | date | When the incident occurred | |
| type | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |
| location[x] | 0..1 | Where the event occurred | ||
| locationAddress | Address | |||
| locationReference | Reference(Location) | |||
| item | S | 1..50 | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| referralNumber | S | 0..11 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| estimatedDateOfService | S | 0..1 | date, Period | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService |
| gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| careTeamSequence | 0..* | positiveInt | Applicable careTeam members | |
| diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | |
| procedureSequence | 0..* | positiveInt | Applicable procedures | |
| informationSequence | 0..* | positiveInt | Applicable exception and supporting information | |
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item CPT - HCPCS Value Set (required) | |
| modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required) |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |
| serviced[x] | 0..1 | Date or dates of service or product delivery | ||
| servicedDate | date | |||
| servicedPeriod | Period | |||
| Slices for location[x] | 1..1 | CodeableConcept | Place of service or where product was supplied Slice: Unordered, Closed by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | |
| location[x]:locationCodeableConcept | S | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required) |
| quantity | S | 1..1 | SimpleQuantity | Count of products or services |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | S | 1..1 | Money | Total item cost |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | |
| detail | S | 0..* | BackboneElement | Drug Identification Information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| compoundDrugLinkingNum | S | 0..1 | id, integer | Compound Drug Linking Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/compoundDrugLinkingNum |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required) | |
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |
| quantity | S | 0..1 | SimpleQuantity | Count of products or services |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| subDetail | 0..* | BackboneElement | Product or service provided | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |
| quantity | 0..1 | SimpleQuantity | Count of products or services | |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| total | 1..1 | Money | Total GFE Charges Submitted | |
| Documentation for this format | ||||
This structure is derived from Claim
Summary
Mandatory: 12 elements (8 nested mandatory elements)
Must-Support: 47 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |
| Slices for extension | 2..* | Extension | Extension Slice: Unordered, Open by value:url | |
| gfeSubmitter | S | 1..1 | Reference(PCT Organization | PCT Practitioner) | The scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeSubmitter |
| gfeProviderAssignedIdentifier | S | 1..1 | Identifier | GFE Provider Assigned Identifier URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeProviderAssignedIdentifier |
| gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo |
| providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology |
| interTransIdentifier | S | 0..1 | Identifier | Intermediary Transmission Identifier URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/interTransIdentifier |
| type | 1..1 | CodeableConcept | Category or discipline Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Professional | |
| use | 1..1 | code | claim | preauthorization | predetermination Required Pattern: predetermination | |
| patient | S | 1..1 | Reference(PCT Patient) | The recipient of the products and services |
| insurer | 1..1 | Reference(PCT Organization) | Target | |
| provider | 1..1 | Reference(PCT Organization | PCT PractitionerRole) | Billing provider - party responsible for the GFE | |
| priority | S | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required) |
| payee | S | 0..1 | BackboneElement | Recipient of benefits payable |
| party | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |
| referral | ||||
| extension | 1..* | Extension | Extension | |
| referralNumber | S | 1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| facility | S | 0..1 | Reference(PCT Location) | Servicing facility |
| Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role |
| careTeam:All Slices | Content/Rules for all slices | |||
| provider | S | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization |
| role | S | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| qualification | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required) |
| careTeam:rendering | S | 0..2 | BackboneElement | Members of the care team |
| role | 0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering | |
| qualification | 1..1 | CodeableConcept | Practitioner credential or specialization - must provide a taxonomy code for the Professional case | |
| careTeam:referring | S | 0..1 | BackboneElement | Members of the care team |
| role | 0..1 | CodeableConcept | Function within the team Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring | |
| Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category |
| supportingInfo:All Slices | Content/Rules for all slices | |||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (extensible) | |
| supportingInfo:placeOfService | S | 0..1 | BackboneElement | Supporting information |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: cmspos | |
| display | 1..1 | string | Representation defined by the system Fixed Value: CMS Place of Service | |
| code | S | 1..1 | CodeableConcept | Type of information Binding: PCT GFE CMS Place of Service Value Set (required) |
| Slices for diagnosis | S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type |
| diagnosis:All Slices | Content/Rules for all slices | |||
| type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: PCT Diagnosis Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| diagnosis:principal | S | 1..1 | BackboneElement | Pertinent diagnosis information |
| sequence | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1 | |
| diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) |
| type | 1..* | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal | |
| packageCode | S | 0..1 | CodeableConcept | For the Professional case this is the Provider GFE Grouper Methodology |
| diagnosis:other | S | 0..11 | BackboneElement | Pertinent diagnosis information |
| diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) |
| type | 1..* | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| packageCode | S | 0..1 | CodeableConcept | For the Professional case this is the Provider GFE Grouper Methodology |
| Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type |
| procedure:All Slices | Content/Rules for all slices | |||
| type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed |
| type | 1..* | CodeableConcept | Category of Procedure Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia | |
| procedure[x] | S | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) |
| procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed |
| type | 1..* | CodeableConcept | Category of Procedure Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| procedure[x] | S | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) |
| insurance | ||||
| coverage | S | 1..1 | Reference(PCT Coverage) | Insurance information |
| preAuthRef | S | 0..2 | string | Prior authorization reference number |
| item | S | 1..50 | BackboneElement | Product or service provided |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| referralNumber | S | 0..11 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| estimatedDateOfService | S | 0..1 | date, Period | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService |
| gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item CPT - HCPCS Value Set (required) | |
| modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required) |
| Slices for location[x] | 1..1 | CodeableConcept | Place of service or where product was supplied Slice: Unordered, Open by type:$this | |
| locationCodeableConcept | S | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required) |
| quantity | S | 1..1 | SimpleQuantity | Count of products or services |
| net | S | 1..1 | Money | Total item cost |
| detail | S | 0..* | BackboneElement | Drug Identification Information |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| compoundDrugLinkingNum | S | 0..1 | id, integer | Compound Drug Linking Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/compoundDrugLinkingNum |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required) | |
| quantity | S | 0..1 | SimpleQuantity | Count of products or services |
| total | 1..1 | Money | Total GFE Charges Submitted | |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |
| id | Σ | 0..1 | string | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| Slices for extension | 2..* | Extension | Extension Slice: Unordered, Open by value:url | |
| gfeSubmitter | S | 1..1 | Reference(PCT Organization | PCT Practitioner) | The scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeSubmitter |
| gfeProviderAssignedIdentifier | S | 1..1 | Identifier | GFE Provider Assigned Identifier URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeProviderAssignedIdentifier |
| gfeServiceLinkingInfo | S | 0..1 | (Complex) | GFE Service Linking Information URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo |
| providerEventMethodology | S | 0..1 | string | Provider event collection methodology URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology |
| interTransIdentifier | S | 0..1 | Identifier | Intermediary Transmission Identifier URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/interTransIdentifier |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | 0..* | Identifier | Business Identifier for claim | |
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
| type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Professional | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| subType | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |
| use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination |
| patient | SΣ | 1..1 | Reference(PCT Patient) | The recipient of the products and services |
| billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim |
| created | Σ | 1..1 | dateTime | Resource creation date |
| enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |
| insurer | Σ | 1..1 | Reference(PCT Organization) | Target |
| provider | Σ | 1..1 | Reference(PCT Organization | PCT PractitionerRole) | Billing provider - party responsible for the GFE |
| priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required) |
| fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |
| related | 0..* | BackboneElement | Prior or corollary claims | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| claim | 0..1 | Reference(Claim) | Reference to the related claim | |
| relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |
| reference | 0..1 | Identifier | File or case reference | |
| prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |
| originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |
| payee | S | 0..1 | BackboneElement | Recipient of benefits payable |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |
| party | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |
| referral | 0..1 | Reference(ServiceRequest) | Treatment referral | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| referralNumber | S | 1..1 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| reference | ΣI | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). |
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
| display | Σ | 0..1 | string | Text alternative for the resource |
| facility | S | 0..1 | Reference(PCT Location) | Servicing facility |
| Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role |
| careTeam:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Order of care team | |
| provider | S | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization |
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |
| role | S | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| qualification | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required) |
| careTeam:rendering | S | 0..2 | BackboneElement | Members of the care team |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Order of care team | |
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |
| role | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| qualification | 1..1 | CodeableConcept | Practitioner credential or specialization - must provide a taxonomy code for the Professional case Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |
| careTeam:referring | S | 0..1 | BackboneElement | Members of the care team |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Order of care team | |
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |
| role | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |
| Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category |
| supportingInfo:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Information instance identifier | |
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: PCT Supporting Info Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (extensible) | |
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(Resource) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |
| supportingInfo:placeOfService | S | 0..1 | BackboneElement | Supporting information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Information instance identifier | |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: cmspos | |
| display | 1..1 | string | Representation defined by the system Fixed Value: CMS Place of Service | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| code | S | 1..1 | CodeableConcept | Type of information Binding: PCT GFE CMS Place of Service Value Set (required) |
| timing[x] | 0..1 | When it occurred | ||
| timingDate | date | |||
| timingPeriod | Period | |||
| value[x] | 0..1 | Data to be provided | ||
| valueBoolean | boolean | |||
| valueString | string | |||
| valueQuantity | Quantity | |||
| valueAttachment | Attachment | |||
| valueReference | Reference(Resource) | |||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |
| Slices for diagnosis | S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type |
| diagnosis:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | |
| diagnosis[x] | 1..1 | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||
| diagnosisCodeableConcept | CodeableConcept | |||
| diagnosisReference | Reference(Condition) | |||
| type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: PCT Diagnosis Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |
| diagnosis:principal | S | 1..1 | BackboneElement | Pertinent diagnosis information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1 | |
| diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) |
| type | 1..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |
| packageCode | S | 0..1 | CodeableConcept | For the Professional case this is the Provider GFE Grouper Methodology Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. |
| diagnosis:other | S | 0..11 | BackboneElement | Pertinent diagnosis information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | |
| diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required) |
| type | 1..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |
| packageCode | S | 0..1 | CodeableConcept | For the Professional case this is the Provider GFE Grouper Methodology Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. |
| Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type |
| procedure:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Procedure instance identifier | |
| type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required) |
| date | 0..1 | dateTime | When the procedure was performed | |
| procedure[x] | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||
| procedureCodeableConcept | CodeableConcept | |||
| procedureReference | Reference(Procedure) | |||
| udi | 0..* | Reference(Device) | Unique device identifier | |
| procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Procedure instance identifier | |
| type | 1..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| date | 0..1 | dateTime | When the procedure was performed | |
| procedure[x] | S | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Procedure instance identifier | |
| type | 1..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. Required Pattern: At least the following | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType | |
| version | 0..1 | string | Version of the system - if relevant | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other | |
| display | 0..1 | string | Representation defined by the system | |
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |
| text | 0..1 | string | Plain text representation of the concept | |
| date | 0..1 | dateTime | When the procedure was performed | |
| procedure[x] | S | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required) |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| insurance | Σ | 1..* | BackboneElement | Patient insurance information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier |
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication |
| identifier | 0..1 | Identifier | Pre-assigned Claim number | |
| coverage | SΣ | 1..1 | Reference(PCT Coverage) | Insurance information |
| businessArrangement | 0..1 | string | Additional provider contract number | |
| preAuthRef | S | 0..2 | string | Prior authorization reference number |
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |
| accident | 0..1 | BackboneElement | Details of the event | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| date | 1..1 | date | When the incident occurred | |
| type | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |
| location[x] | 0..1 | Where the event occurred | ||
| locationAddress | Address | |||
| locationReference | Reference(Location) | |||
| item | S | 1..50 | BackboneElement | Product or service provided |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| referralNumber | S | 0..11 | string | Referral Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber |
| estimatedDateOfService | S | 0..1 | date, Period | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService |
| gfeBillingProviderLineItemCtrlNum | S | 0..1 | Identifier | Extension URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| careTeamSequence | 0..* | positiveInt | Applicable careTeam members | |
| diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | |
| procedureSequence | 0..* | positiveInt | Applicable procedures | |
| informationSequence | 0..* | positiveInt | Applicable exception and supporting information | |
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item CPT - HCPCS Value Set (required) | |
| modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: PCT GFE Item CPT - HCPCS Value Set (required) |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |
| serviced[x] | 0..1 | Date or dates of service or product delivery | ||
| servicedDate | date | |||
| servicedPeriod | Period | |||
| Slices for location[x] | 1..1 | CodeableConcept | Place of service or where product was supplied Slice: Unordered, Closed by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | |
| location[x]:locationCodeableConcept | S | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: PCT GFE CMS Place of Service Value Set (required) |
| quantity | S | 1..1 | SimpleQuantity | Count of products or services |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | S | 1..1 | Money | Total item cost |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | |
| detail | S | 0..* | BackboneElement | Drug Identification Information |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| compoundDrugLinkingNum | S | 0..1 | id, integer | Compound Drug Linking Number URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/compoundDrugLinkingNum |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: PCT GFE Item NDC Value Set (required) | |
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |
| quantity | S | 0..1 | SimpleQuantity | Count of products or services |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| subDetail | 0..* | BackboneElement | Product or service provided | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |
| quantity | 0..1 | SimpleQuantity | Count of products or services | |
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |
| factor | 0..1 | decimal | Price scaling factor | |
| net | 0..1 | Money | Total item cost | |
| udi | 0..* | Reference(Device) | Unique device identifier | |
| total | 1..1 | Money | Total GFE Charges Submitted | |
| Documentation for this format | ||||
Other representations of profile: CSV, Excel, Schematron
| Path | Conformance | ValueSet / Code |
| Claim.language | preferred | CommonLanguages Max Binding: AllLanguages |
| Claim.status | required | FinancialResourceStatusCodes |
| Claim.type | extensible | Pattern: professional("Professional") |
| Claim.subType | example | ExampleClaimSubTypeCodes |
| Claim.use | required | Pattern: predetermination |
| Claim.priority | required | ProcessPriorityCodes |
| Claim.fundsReserve | example | Funds Reservation Codes |
| Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodes |
| Claim.payee.type | example | Claim Payee Type Codes |
| Claim.referral.type | extensible | ResourceType |
| Claim.careTeam.role | required | PCTCareTeamRoleVS |
| Claim.careTeam.qualification | required | USCoreProviderRoleNucc |
| Claim.careTeam:rendering.role | example | Pattern: rendering |
| Claim.careTeam:rendering.qualification | example | ExampleProviderQualificationCodes |
| Claim.careTeam:referring.role | example | Pattern: referring |
| Claim.careTeam:referring.qualification | example | ExampleProviderQualificationCodes |
| Claim.supportingInfo.category | extensible | PCTSupportingInfoTypeVS |
| Claim.supportingInfo.code | example | ExceptionCodes |
| Claim.supportingInfo.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:placeOfService.category | example | Pattern: cmspos("CMS Place of Service") |
| Claim.supportingInfo:placeOfService.code | required | PCTGFECMSPOS |
| Claim.supportingInfo:placeOfService.reason | example | MissingToothReasonCodes |
| Claim.diagnosis.diagnosis[x] | example | ICD-10Codes |
| Claim.diagnosis.type | required | PCTDiagnosisTypeVS |
| Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodes |
| Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodes |
| Claim.diagnosis:principal.diagnosis[x] | required | PCTDiagnosticCodes |
| Claim.diagnosis:principal.type | example | Pattern: principal |
| Claim.diagnosis:principal.onAdmission | example | ExampleDiagnosisOnAdmissionCodes |
| Claim.diagnosis:principal.packageCode | example | ExampleDiagnosisRelatedGroupCodes |
| Claim.diagnosis:other.diagnosis[x] | required | PCTDiagnosticCodes |
| Claim.diagnosis:other.type | example | Pattern: other |
| Claim.diagnosis:other.onAdmission | example | ExampleDiagnosisOnAdmissionCodes |
| Claim.diagnosis:other.packageCode | example | ExampleDiagnosisRelatedGroupCodes |
| Claim.procedure.type | required | PCTProcedureTypeVS |
| Claim.procedure.procedure[x] | example | ICD-10ProcedureCodes |
| Claim.procedure:anesthesiaRelated.type | example | Pattern: procedureRequiringAnesthesia |
| Claim.procedure:anesthesiaRelated.procedure[x] | required | PCTProcedureSurgicalCodes |
| Claim.procedure:other.type | example | Pattern: other |
| Claim.procedure:other.procedure[x] | required | PCTProcedureSurgicalCodes |
| Claim.accident.type | extensible | ActIncidentCode |
| Claim.item.revenue | example | ExampleRevenueCenterCodes |
| Claim.item.category | example | BenefitCategoryCodes |
| Claim.item.productOrService | required | PCTGFEItemCptHcpcsVS |
| Claim.item.modifier | required | PCTGFEItemCptHcpcsVS |
| Claim.item.programCode | example | ExampleProgramReasonCodes |
| Claim.item.location[x] | example | ExampleServicePlaceCodes |
| Claim.item.location[x]:locationCodeableConcept | required | PCTGFECMSPOS |
| Claim.item.bodySite | example | OralSiteCodes |
| Claim.item.subSite | example | SurfaceCodes |
| Claim.item.detail.revenue | example | ExampleRevenueCenterCodes |
| Claim.item.detail.category | example | BenefitCategoryCodes |
| Claim.item.detail.productOrService | required | PCTGFEItemNDCVS |
| Claim.item.detail.modifier | example | ModifierTypeCodes |
| Claim.item.detail.programCode | example | ExampleProgramReasonCodes |
| Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodes |
| Claim.item.detail.subDetail.category | example | BenefitCategoryCodes |
| Claim.item.detail.subDetail.productOrService | example | USCLSCodes |
| Claim.item.detail.subDetail.modifier | example | ModifierTypeCodes |
| Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodes |
| 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.extension:gfeSubmitter | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.extension:gfeSubmitter | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.extension:gfeProviderAssignedIdentifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.extension:gfeProviderAssignedIdentifier | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.extension:gfeServiceLinkingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.extension:gfeServiceLinkingInfo | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.extension:providerEventMethodology | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.extension:providerEventMethodology | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.extension:interTransIdentifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.extension:interTransIdentifier | 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.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.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.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.priority | 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.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.referral.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.referral.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.referral.extension:referralNumber | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.referral.extension:referralNumber | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.referral.reference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.referral.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.referral.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.referral.display | 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.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.careTeam:rendering | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:rendering.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.careTeam:rendering.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.careTeam:rendering.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.careTeam:rendering.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.careTeam:rendering.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:rendering.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:rendering.responsible | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:rendering.role | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:rendering.qualification | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:referring | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:referring.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.careTeam:referring.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.careTeam:referring.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.careTeam:referring.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.careTeam:referring.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:referring.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:referring.responsible | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:referring.role | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.careTeam:referring.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.supportingInfo:placeOfService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo:placeOfService.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.supportingInfo:placeOfService.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.supportingInfo:placeOfService.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.supportingInfo:placeOfService.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.supportingInfo:placeOfService.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo:placeOfService.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo:placeOfService.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo:placeOfService.timing[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo:placeOfService.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.supportingInfo:placeOfService.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.diagnosis:principal | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:principal.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.diagnosis:principal.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.diagnosis:principal.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.diagnosis:principal.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.diagnosis:principal.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:principal.diagnosis[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:principal.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:principal.onAdmission | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:principal.packageCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:other | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:other.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.diagnosis:other.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.diagnosis:other.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.diagnosis:other.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.diagnosis:other.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:other.diagnosis[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:other.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:other.onAdmission | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.diagnosis:other.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.procedure:anesthesiaRelated | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:anesthesiaRelated.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.procedure:anesthesiaRelated.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.procedure:anesthesiaRelated.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.procedure:anesthesiaRelated.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.procedure:anesthesiaRelated.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:anesthesiaRelated.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:anesthesiaRelated.date | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:anesthesiaRelated.procedure[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:anesthesiaRelated.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:other | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:other.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.procedure:other.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.procedure:other.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.procedure:other.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.procedure:other.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:other.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:other.date | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:other.procedure[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | Claim.procedure:other.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.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.extension:referralNumber | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.extension:referralNumber | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.extension:estimatedDateOfService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.extension:estimatedDateOfService | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Claim.item.extension:gfeBillingProviderLineItemCtrlNum | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.extension:gfeBillingProviderLineItemCtrlNum | 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.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.location[x]:locationCodeableConcept | 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.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.extension:compoundDrugLinkingNumber | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Claim.item.detail.extension:compoundDrugLinkingNumber | 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 © 2021+ HL7 International - Financial Management Work Group. Package hl7.fhir.us.davinci-pct#0.1.0 based on FHIR 4.0.1. Generated 2021-12-04
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