Patient Cost Transparency Implementation Guide
1.1.0 - STU 1 United States of America flag

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v1.1.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: PCTGFEInstitutional - Detailed Descriptions

Page standards status: Trial-use

Definitions for the davinci-pct-gfe-institutional resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Claim
2. Claim.extension
Control1..?
SlicingThis element introduces a set of slices on Claim.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
4. Claim.extension:gfeSubmitter
Slice NamegfeSubmitter
ShortThe scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB
Control1..1
TypeExtension(GFESubmitter) (Extension Type: Reference(PCT Organization, PCT Practitioner))
6. Claim.extension:gfeServiceLinkingInfo
Slice NamegfeServiceLinkingInfo
ShortGFE Service Linking Information.
Control0..1
TypeExtension(GFEServiceLinkingInfo) (Complex Extension)
Must Supporttrue
8. Claim.extension:providerEventMethodology
Slice NameproviderEventMethodology
Definition

How the provider determined the number of claims and the number and type of billing providers to include in the GFE. Examples include provider episodes of care experience, PACES, order set based on clinical guidelines, payor suggested grouping, or some other method of determination. The extension deifnition contains additional detail.

ShortProvider event collection methodology
Control0..1
TypeExtension(ProviderEventMethodology) (Extension Type: string)
Must Supporttrue
10. Claim.extension:gfeDisclaimer
Slice NamegfeDisclaimer
ShortDisclaimers the patient should be made aware of regarding the providers estimate
Control0..*
TypeExtension(GFEDisclaimer) (Extension Type: string)
Must Supporttrue
12. Claim.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..?
SlicingThis element introduces a set of slices on Claim.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
14. Claim.identifier:PLAC
Slice NamePLAC
ShortProvider Assigned Identifier for GFE Claim
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1
16. Claim.identifier:PLAC.type
Control1..?
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/v2-0203&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;PLAC&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;display&nbsp;value=&quot;Placer&nbsp;Identifier&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
18. Claim.identifier:PLAC.system
Must Supporttrue
20. Claim.identifier:PLAC.value
Control1..?
22. Claim.identifier:INTER
Slice NameINTER
ShortIntermediary System Identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
24. Claim.identifier:INTER.type
Control1..?
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;INTER&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;display&nbsp;value=&quot;Intermediary&nbsp;System&nbsp;Identifier&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
26. Claim.type
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/claim-type&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;institutional&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
28. Claim.use
Pattern Valuepredetermination
30. Claim.patient
TypeReference(HRex Patient Demographics)
32. Claim.billablePeriod
ShortRelevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
Must Supporttrue
34. Claim.insurer
Control1..?
TypeReference(PCT Organization)
36. Claim.provider
ShortBilling provider - party responsible for the GFE
TypeReference(PCT Organization)
38. Claim.provider.extension
Control1..?
40. Claim.provider.extension:providerTaxonomy
Slice NameproviderTaxonomy
ShortProvider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
Control1..1
TypeExtension(ProviderTaxonomy) (Extension Type: CodeableConcept)
42. Claim.provider.extension:consentForBalanceBilling
Slice NameconsentForBalanceBilling
Control0..1
TypeExtension(GFEConsentForBalanceBilling) (Extension Type: boolean)
Must Supporttrue
44. Claim.priority
BindingThe codes SHALL be taken from ProcessPriorityCodes
46. Claim.payee
Must Supporttrue
48. Claim.payee.party
TypeReference(PCT Practitioner, PCT Organization)
50. Claim.referral
52. Claim.referral.extension
Control1..?
54. Claim.referral.extension:referralNumber
Slice NamereferralNumber
ShortReferral Number
Control1..1
TypeExtension(ReferralNumber) (Extension Type: string)
56. Claim.careTeam
Must Supporttrue
SlicingThis element introduces a set of slices on Claim.careTeam. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ role
58. Claim.careTeam.provider
TypeReference(PCT Practitioner, PCT Organization)
60. Claim.careTeam.role
Control1..?
BindingThe codes SHALL be taken from PCT Care Team Role Value Set
62. Claim.careTeam.qualification
BindingThe codes SHALL be taken from US Core Provider Role (NUCC)
64. Claim.careTeam:attending
Slice Nameattending
Control0..1
Must Supporttrue
66. Claim.careTeam:attending.provider
TypeReference(PCT Practitioner)
68. Claim.careTeam:attending.role
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;attending&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
70. Claim.careTeam:attending.qualification
Control1..?
72. Claim.careTeam:operating
Slice Nameoperating
Control0..2
Must Supporttrue
74. Claim.careTeam:operating.provider
TypeReference(PCT Practitioner)
76. Claim.careTeam:operating.role
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;operating&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
78. Claim.careTeam:rendering
Slice Namerendering
Control0..1
Must Supporttrue
80. Claim.careTeam:rendering.provider
TypeReference(PCT Practitioner)
82. Claim.careTeam:rendering.role
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;rendering&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
84. Claim.careTeam:referring
Slice Namereferring
Control0..1
Must Supporttrue
86. Claim.careTeam:referring.role
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;referring&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
88. Claim.supportingInfo
Control1..?
Must Supporttrue
SlicingThis element introduces a set of slices on Claim.supportingInfo. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ category
90. Claim.supportingInfo.category
BindingUnless not suitable, these codes SHALL be taken from PCT Supporting Info Type Value Set
92. Claim.supportingInfo:typeOfBill
Slice NametypeOfBill
Control1..1
94. Claim.supportingInfo:typeOfBill.category
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;typeofbill&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
96. Claim.supportingInfo:typeOfBill.code
Control1..?
BindingThe codes SHALL be taken from PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set
98. Claim.supportingInfo:serviceFacility
Slice NameserviceFacility
ShortService Facility
Comments

Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider.

Control0..1
Must Supporttrue
100. Claim.supportingInfo:serviceFacility.category
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;servicefacility&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
102. Claim.supportingInfo:serviceFacility.value[x]
Control1..?
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on Claim.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
104. Claim.supportingInfo:serviceFacility.value[x]:valueReference
Slice NamevalueReference
Control1..1
TypeReference(PCT Organization)
[x] NoteSee Choice of Data Types for further information about how to use [x]
106. Claim.supportingInfo:drg
Slice Namedrg
Control0..1
108. Claim.supportingInfo:drg.category
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;drg&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
110. Claim.supportingInfo:drg.code
BindingThe codes SHALL be taken from US Claim DRG Codes
112. Claim.supportingInfo:pointoforigin
Slice Namepointoforigin
Control0..1
114. Claim.supportingInfo:pointoforigin.category
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;pointoforigin&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
116. Claim.supportingInfo:pointoforigin.code
BindingThe codes SHALL be taken from NUBC Point Of Origin
118. Claim.supportingInfo:admtype
Slice Nameadmtype
Control0..1
120. Claim.supportingInfo:admtype.category
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;admtype&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
122. Claim.supportingInfo:admtype.code
BindingThe codes SHALL be taken from NUBC Priority (Type) of Admission or Visit
124. Claim.diagnosis
Control1..?
Must Supporttrue
SlicingThis element introduces a set of slices on Claim.diagnosis. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
126. Claim.diagnosis.type
BindingThe codes SHALL be taken from PCT Diagnosis Type Value Set
Must Supporttrue
128. Claim.diagnosis:principal
Slice Nameprincipal
Control1..1
130. Claim.diagnosis:principal.sequence
Pattern Value1
132. Claim.diagnosis:principal.diagnosis[x]
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
134. Claim.diagnosis:principal.type
Control1..1
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/ex-diagnosistype&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;principal&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
136. Claim.diagnosis:admitting
Slice Nameadmitting
Control0..1
Must Supporttrue
138. Claim.diagnosis:admitting.diagnosis[x]
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
140. Claim.diagnosis:admitting.type
Control1..1
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/ex-diagnosistype&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;admitting&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
142. Claim.diagnosis:patientReasonForVisit
Slice NamepatientReasonForVisit
Control0..3
Must Supporttrue
144. Claim.diagnosis:patientReasonForVisit.diagnosis[x]
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
146. Claim.diagnosis:patientReasonForVisit.type
Control1..1
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;patientReasonForVisit&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
148. Claim.diagnosis:externalcauseofinjury
Slice Nameexternalcauseofinjury
Control0..12
Must Supporttrue
150. Claim.diagnosis:externalcauseofinjury.diagnosis[x]
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
152. Claim.diagnosis:externalcauseofinjury.type
Control1..1
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;externalCauseOfInjury&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
154. Claim.diagnosis:other
Slice Nameother
Control0..24
Must Supporttrue
156. Claim.diagnosis:other.diagnosis[x]
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
158. Claim.diagnosis:other.type
Control1..1
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;other&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
160. Claim.procedure
Must Supporttrue
SlicingThis element introduces a set of slices on Claim.procedure. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
162. Claim.procedure.extension
Control1..?
SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
164. Claim.procedure.extension:serviceDescription
Slice NameserviceDescription
Control1..1
TypeExtension(Service Description) (Extension Type: string)
166. Claim.procedure.type
BindingThe codes SHALL be taken from PCT Procedure Type Value Set
Must Supporttrue
168. Claim.procedure:principal
Slice Nameprincipal
ShortPrincipal clinical procedure performed
Control0..1
Must Supporttrue
170. Claim.procedure:principal.extension:serviceDescription
Slice NameserviceDescription
Control1..1
TypeExtension(Service Description) (Extension Type: string)
172. Claim.procedure:principal.sequence
Pattern Value1
174. Claim.procedure:principal.type
Control1..1
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;principal&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
176. Claim.procedure:principal.procedure[x]
BindingThe codes SHALL be taken from ICD-10 Procedure Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
178. Claim.procedure:other
Slice Nameother
Control0..24
Must Supporttrue
180. Claim.procedure:other.extension:serviceDescription
Slice NameserviceDescription
Control1..1
TypeExtension(Service Description) (Extension Type: string)
182. Claim.procedure:other.type
Control1..1
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;other&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
184. Claim.procedure:other.procedure[x]
BindingThe codes SHALL be taken from PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
186. Claim.insurance
188. Claim.insurance.coverage
TypeReference(PCT Coverage)
190. Claim.insurance.preAuthRef
Control0..1
192. Claim.accident
194. Claim.accident.location[x]
TypeAddress, Reference(Location)
[x] NoteSee Choice of Data Types for further information about how to use [x]
196. Claim.accident.location[x].country
BindingThe codes SHALL be taken from Iso3166-1-2
198. Claim.item
Control1..999
200. Claim.item.extension
Control1..?
SlicingThis element introduces a set of slices on Claim.item.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
202. Claim.item.extension:gfeBillingProviderLineItemCtrlNum
Slice NamegfeBillingProviderLineItemCtrlNum
Control0..1
TypeExtension(GFEBillingProviderLineItemCtrlNum) (Extension Type: Identifier)
Must Supporttrue
204. Claim.item.extension:serviceDescription
Slice NameserviceDescription
Control1..1
TypeExtension(Service Description) (Extension Type: string)
206. Claim.item.extension:ProviderEventMethodology
Slice NameProviderEventMethodology
ShortProvider Event Methodology
Comments

The method a provider used to group services. The extension definition contains additional detail

Control0..1
TypeExtension(ProviderEventMethodology) (Extension Type: string)
Must Supporttrue
208. Claim.item.revenue
ShortRevenue or cost center code - must provide a value for the Institutional case
Control1..?
BindingThe codes SHALL be taken from PCT GFE NUBC Revenue Value Set
210. Claim.item.productOrService
Comments

Can include null or N/A or data absent reason for the In-Patient Institutional case.

BindingThe codes SHALL be taken from Claim Medical Product or Service Value Set
212. Claim.item.modifier
Control0..4
BindingThe codes SHALL be taken from PCT GFE Item CPT - HCPCS Value Set
Must Supporttrue
214. Claim.item.serviced[x]
Definition

This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication

ShortThis is the planned or estimated date(s)s of service
Control1..?
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
216. Claim.item.location[x]
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on Claim.item.location[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
218. Claim.item.location[x]:locationCodeableConcept
Slice NamelocationCodeableConcept
Control0..1
BindingThe codes SHALL be taken from PCT GFE CMS Place of Service Value Set
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
220. Claim.item.quantity
Control1..?
222. Claim.item.net
ShortTotal charge amount for the service line
Control1..?
224. Claim.item.detail
ShortDrug Identification Information
Must Supporttrue
226. Claim.item.detail.productOrService
BindingThe codes SHALL be taken from PCT GFE Item NDC Value Set
228. Claim.item.detail.quantity
Must Supporttrue
230. Claim.total
ShortTotal GFE Charges Submitted
Control1..?

Guidance on how to interpret the contents of this table can be found here

0. Claim
Definition

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

ShortClaim, Pre-determination or Pre-authorization
Comments

The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Claim.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Claim.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control10..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
6. Claim.extension:gfeSubmitter
Slice NamegfeSubmitter
Definition

This extension is used to indicate the scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB. All submitters (Practitioners and Organizations) must have an ETIN.

ShortThe scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(GFESubmitter) (Extension Type: Reference(PCT Organization, PCT Practitioner))
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. Claim.extension:gfeServiceLinkingInfo
Slice NamegfeServiceLinkingInfo
Definition

This extension is used to provide the GFE Service Linking Information. This allows implementers to have the same identifier on multiple GFEs that are part of one period of care's services. This would be needed for some of the workflow options that businesses may decide to use.

ShortGFE Service Linking Information.
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(GFEServiceLinkingInfo) (Complex Extension)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
10. Claim.extension:providerEventMethodology
Slice NameproviderEventMethodology
Definition

How the provider determined the number of claims and the number and type of billing providers to include in the GFE. Examples include provider episodes of care experience, PACES, order set based on clinical guidelines, payor suggested grouping, or some other method of determination. The extension deifnition contains additional detail.

ShortProvider event collection methodology
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(ProviderEventMethodology) (Extension Type: string)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
12. Claim.extension:gfeDisclaimer
Slice NamegfeDisclaimer
Definition

Disclaimers the patient should be made aware of regarding the providers estimate

ShortDisclaimers the patient should be made aware of regarding the providers estimate
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(GFEDisclaimer) (Extension Type: string)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
14. Claim.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
16. Claim.identifier
Definition

A unique identifier assigned to this claim.

ShortBusiness Identifier for claim
NoteThis is a business identifier, not a resource identifier (see discussion)
Control10..*
TypeIdentifier
Is Modifierfalse
Summaryfalse
Requirements

Allows claims to be distinguished and referenced.

Alternate NamesClaim Number
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
18. Claim.identifier:PLAC
Slice NamePLAC
Definition

A unique identifier assigned to this claim.

ShortProvider Assigned Identifier for GFE ClaimBusiness Identifier for claim
NoteThis is a business identifier, not a resource identifier (see discussion)
Control10..1*
TypeIdentifier
Is Modifierfalse
Summaryfalse
Requirements

Allows claims to be distinguished and referenced.

Alternate NamesClaim Number
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. Claim.identifier:PLAC.use
Definition

The purpose of this identifier.

Shortusual | official | temp | secondary | old (If known)
Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control0..1
BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue because This is labeled as &quot;Is Modifier&quot; because applications should not mistake a temporary id for a permanent one.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. Claim.identifier:PLAC.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

ShortDescription of identifier
Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Control10..1
BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/v2-0203&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;PLAC&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;display&nbsp;value=&quot;Placer&nbsp;Identifier&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. Claim.identifier:PLAC.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

ShortThe namespace for the identifier value
Comments

Identifier.system is always case sensitive.

Control0..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Claim.identifier:PLAC.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

ShortThe value that is unique
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Example<br/><b>General</b>:123456
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. Claim.identifier:INTER
Slice NameINTER
Definition

A unique identifier assigned to this claim.

ShortIntermediary System IdentifierBusiness Identifier for claim
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Is Modifierfalse
Summaryfalse
Requirements

Allows claims to be distinguished and referenced.

Alternate NamesClaim Number
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Claim.identifier:INTER.use
Definition

The purpose of this identifier.

Shortusual | official | temp | secondary | old (If known)
Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control0..1
BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue because This is labeled as &quot;Is Modifier&quot; because applications should not mistake a temporary id for a permanent one.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. Claim.identifier:INTER.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

ShortDescription of identifier
Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Control10..1
BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;INTER&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;display&nbsp;value=&quot;Intermediary&nbsp;System&nbsp;Identifier&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
34. Claim.status
Definition

The status of the resource instance.

Shortactive | cancelled | draft | entered-in-error
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Control1..1
BindingThe codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1

A code specifying the state of the resource instance.

Typecode
Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. Claim.type
Definition

The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

ShortCategory or discipline
Comments

The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.

Control1..1
BindingUnless not suitable, these codes SHALL be taken from ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type

The type or discipline-style of the claim.

TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

Claim type determine the general sets of business rules applied for information requirements and adjudication.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/claim-type&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;institutional&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. Claim.use
Definition

A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

Shortclaim | preauthorization | predetermination
Control1..1
BindingThe codes SHALL be taken from Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1

The purpose of the Claim: predetermination, preauthorization, claim.

Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

This element is required to understand the nature of the request for adjudication.

Pattern Valuepredetermination
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. Claim.patient
Definition

The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

ShortThe recipient of the products and services
Control1..1
TypeReference(HRex Patient Demographics, Patient)
Is Modifierfalse
Summarytrue
Requirements

The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. Claim.billablePeriod
Definition

The period for which charges are being submitted.

ShortRelevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
Comments

Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.

Control0..1
TypePeriod
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
44. Claim.created
Definition

The date this resource was created.

ShortResource creation date
Comments

This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

Control1..1
TypedateTime
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to record a timestamp for use by both the recipient and the issuer.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
46. Claim.insurer
Definition

The Insurer who is target of the request.

ShortTarget
Control10..1
TypeReference(PCT Organization, Organization)
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
48. Claim.provider
Definition

The provider which is responsible for the claim, predetermination or preauthorization.

ShortBilling provider - party responsible for the GFEParty responsible for the claim
Comments

Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

Control1..1
TypeReference(PCT Organization, Practitioner, PractitionerRole, Organization)
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
50. Claim.provider.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control10..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.provider.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
52. Claim.provider.extension:providerTaxonomy
Slice NameproviderTaxonomy
Definition

This extension is used to indicate the taxonomy code of the provider.

ShortProvider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
Control1..1
TypeExtension(ProviderTaxonomy) (Extension Type: CodeableConcept)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
54. Claim.provider.extension:consentForBalanceBilling
Slice NameconsentForBalanceBilling
Definition

If the provider has received a written consent form indicating a patient has agreed to waive their protections and pay up to the full cost for the out-of-network item or service, this will be “true”. If the provider has not received written consent, this will be “false”. This is an attestation only. The billing provider is legally required to maintain the written notice and consent form.

ShortExtension
Control0..1
TypeExtension(GFEConsentForBalanceBilling) (Extension Type: boolean)
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
56. Claim.priority
Definition

The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

ShortDesired processing ugency
Comments

If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.

Control1..1
BindingThe codes SHALL be taken from For example codes, see ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority
TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
58. Claim.payee
Definition

The party to be reimbursed for cost of the products and services according to the terms of the policy.

ShortRecipient of benefits payable
Comments

Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead.

Control0..1
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
60. Claim.payee.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
62. Claim.payee.type
Definition

Type of Party to be reimbursed: subscriber, provider, other.

ShortCategory of recipient
Control1..1
BindingFor example codes, see Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype

A code for the party to be reimbursed.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
64. Claim.payee.party
Definition

Reference to the individual or organization to whom any payment will be made.

ShortRecipient reference
Comments

Not required if the payee is 'subscriber' or 'provider'.

Control0..1
TypeReference(PCT Practitioner, PCT Organization, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson)
Is Modifierfalse
Summaryfalse
Requirements

Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. Claim.careTeam
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.careTeam. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ role
68. Claim.careTeam.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
70. Claim.careTeam.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
72. Claim.careTeam.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(PCT Practitioner, PCT Organization, Practitioner, PractitionerRole, Organization)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
74. Claim.careTeam.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control10..1
BindingThe codes SHALL be taken from For example codes, see PCT Care Team Role Value Sethttp://hl7.org/fhir/ValueSet/claim-careteamrole
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
76. Claim.careTeam.qualification
Definition

The qualification of the practitioner which is applicable for this service.

ShortPractitioner credential or specialization
Control0..1
BindingThe codes SHALL be taken from For example codes, see US Core Provider Role (NUCC)http://hl7.org/fhir/ValueSet/provider-qualification
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to specify which qualification a provider is delivering the product or service under.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
78. Claim.careTeam:attending
Slice Nameattending
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..1*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
80. Claim.careTeam:attending.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
82. Claim.careTeam:attending.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
84. Claim.careTeam:attending.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(PCT Practitioner, Practitioner, PractitionerRole, Organization)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
86. Claim.careTeam:attending.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control0..1
BindingFor example codes, see ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole

The role codes for the care team members.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;attending&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
88. Claim.careTeam:attending.qualification
Definition

The qualification of the practitioner which is applicable for this service.

ShortPractitioner credential or specialization
Control10..1
BindingFor example codes, see ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualification

Provider professional qualifications.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to specify which qualification a provider is delivering the product or service under.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
90. Claim.careTeam:operating
Slice Nameoperating
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..2*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
92. Claim.careTeam:operating.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
94. Claim.careTeam:operating.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
96. Claim.careTeam:operating.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(PCT Practitioner, Practitioner, PractitionerRole, Organization)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
98. Claim.careTeam:operating.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control0..1
BindingFor example codes, see ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole

The role codes for the care team members.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;operating&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
100. Claim.careTeam:rendering
Slice Namerendering
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..1*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
102. Claim.careTeam:rendering.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
104. Claim.careTeam:rendering.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
106. Claim.careTeam:rendering.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(PCT Practitioner, Practitioner, PractitionerRole, Organization)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
108. Claim.careTeam:rendering.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control0..1
BindingFor example codes, see ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole

The role codes for the care team members.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;rendering&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
110. Claim.careTeam:referring
Slice Namereferring
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..1*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
112. Claim.careTeam:referring.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
114. Claim.careTeam:referring.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
116. Claim.careTeam:referring.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(Practitioner, PractitionerRole, Organization)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
118. Claim.careTeam:referring.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control0..1
BindingFor example codes, see ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole

The role codes for the care team members.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;referring&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
120. Claim.supportingInfo
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control10..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.supportingInfo. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ category
122. Claim.supportingInfo.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
124. Claim.supportingInfo.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
126. Claim.supportingInfo.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingUnless not suitable, these codes SHALL be taken from For example codes, see PCT Supporting Info Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
128. Claim.supportingInfo:typeOfBill
Slice NametypeOfBill
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control10..1*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
130. Claim.supportingInfo:typeOfBill.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
132. Claim.supportingInfo:typeOfBill.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
134. Claim.supportingInfo:typeOfBill.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;typeofbill&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
136. Claim.supportingInfo:typeOfBill.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control10..1
BindingThe codes SHALL be taken from For example codes, see PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Sethttp://hl7.org/fhir/ValueSet/claim-exception
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
138. Claim.supportingInfo:serviceFacility
Slice NameserviceFacility
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortService FacilitySupporting information
Comments

Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider.


Often there are multiple jurisdiction specific valuesets which are required.

Control0..1*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
140. Claim.supportingInfo:serviceFacility.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
142. Claim.supportingInfo:serviceFacility.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
144. Claim.supportingInfo:serviceFacility.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;servicefacility&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
146. Claim.supportingInfo:serviceFacility.value[x]
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

ShortData to be provided
Comments

Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

Control10..1
TypeReference(Resource), boolean, string, Quantity, Attachment
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
148. Claim.supportingInfo:serviceFacility.value[x]:valueReference
Slice NamevalueReference
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

ShortData to be provided
Comments

Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

Control10..1
TypeReference(PCT Organization, Resource), boolean, string, Quantity, Attachment
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
150. Claim.supportingInfo:drg
Slice Namedrg
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control0..1*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
152. Claim.supportingInfo:drg.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
154. Claim.supportingInfo:drg.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
156. Claim.supportingInfo:drg.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;drg&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
158. Claim.supportingInfo:drg.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control0..1
BindingThe codes SHALL be taken from For example codes, see US Claim DRG Codeshttp://hl7.org/fhir/ValueSet/claim-exception
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
160. Claim.supportingInfo:pointoforigin
Slice Namepointoforigin
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control0..1*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
162. Claim.supportingInfo:pointoforigin.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
164. Claim.supportingInfo:pointoforigin.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
166. Claim.supportingInfo:pointoforigin.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;pointoforigin&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
168. Claim.supportingInfo:pointoforigin.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control0..1
BindingThe codes SHALL be taken from For example codes, see NUBC Point Of Originhttp://hl7.org/fhir/ValueSet/claim-exception
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
170. Claim.supportingInfo:admtype
Slice Nameadmtype
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control0..1*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
172. Claim.supportingInfo:admtype.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
174. Claim.supportingInfo:admtype.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
176. Claim.supportingInfo:admtype.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;admtype&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
178. Claim.supportingInfo:admtype.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control0..1
BindingThe codes SHALL be taken from For example codes, see NUBC Priority (Type) of Admission or Visithttp://hl7.org/fhir/ValueSet/claim-exception
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
180. Claim.diagnosis
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control10..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.diagnosis. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
182. Claim.diagnosis.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
184. Claim.diagnosis.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
186. Claim.diagnosis.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingFor example codes, see ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10

Example ICD10 Diagnostic codes.

TypeChoice of: CodeableConcept, Reference(Condition)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
188. Claim.diagnosis.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control0..*
BindingThe codes SHALL be taken from For example codes, see PCT Diagnosis Type Value Sethttp://hl7.org/fhir/ValueSet/ex-diagnosistype
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
190. Claim.diagnosis:principal
Slice Nameprincipal
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control10..1*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
192. Claim.diagnosis:principal.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
194. Claim.diagnosis:principal.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Pattern Value1
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
196. Claim.diagnosis:principal.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10
TypeCodeableConcept, Reference(Condition)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
198. Claim.diagnosis:principal.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control10..1*
BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/ex-diagnosistype&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;principal&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
200. Claim.diagnosis:admitting
Slice Nameadmitting
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control0..1*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
202. Claim.diagnosis:admitting.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
204. Claim.diagnosis:admitting.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
206. Claim.diagnosis:admitting.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10
TypeCodeableConcept, Reference(Condition)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
208. Claim.diagnosis:admitting.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control10..1*
BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/ex-diagnosistype&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;admitting&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
210. Claim.diagnosis:patientReasonForVisit
Slice NamepatientReasonForVisit
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control0..3*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
212. Claim.diagnosis:patientReasonForVisit.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
214. Claim.diagnosis:patientReasonForVisit.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
216. Claim.diagnosis:patientReasonForVisit.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10
TypeCodeableConcept, Reference(Condition)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
218. Claim.diagnosis:patientReasonForVisit.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control10..1*
BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;patientReasonForVisit&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
220. Claim.diagnosis:externalcauseofinjury
Slice Nameexternalcauseofinjury
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control0..12*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
222. Claim.diagnosis:externalcauseofinjury.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
224. Claim.diagnosis:externalcauseofinjury.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
226. Claim.diagnosis:externalcauseofinjury.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10
TypeCodeableConcept, Reference(Condition)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
228. Claim.diagnosis:externalcauseofinjury.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control10..1*
BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;externalCauseOfInjury&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
230. Claim.diagnosis:other
Slice Nameother
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control0..24*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
232. Claim.diagnosis:other.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
234. Claim.diagnosis:other.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
236. Claim.diagnosis:other.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from For example codes, see PCT ICD-10 Diagnostic Codeshttp://hl7.org/fhir/ValueSet/icd-10
TypeCodeableConcept, Reference(Condition)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
238. Claim.diagnosis:other.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control10..1*
BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;other&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
240. Claim.procedure
Definition

Procedures performed on the patient relevant to the billing items with the claim.

ShortClinical procedures performed
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.procedure. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
242. Claim.procedure.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control10..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
244. Claim.procedure.extension:serviceDescription
Slice NameserviceDescription
Definition

This extension is used to communicate a plain language description of the procedure, product, or service.

ShortService Description
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(Service Description) (Extension Type: string)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
246. Claim.procedure.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
248. Claim.procedure.sequence
Definition

A number to uniquely identify procedure entries.

ShortProcedure instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
250. Claim.procedure.type
Definition

When the condition was observed or the relative ranking.

ShortCategory of Procedure
Comments

For example: primary, secondary.

Control0..*
BindingThe codes SHALL be taken from For example codes, see PCT Procedure Type Value Sethttp://hl7.org/fhir/ValueSet/ex-procedure-type
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
252. Claim.procedure.procedure[x]
Definition

The code or reference to a Procedure resource which identifies the clinical intervention performed.

ShortSpecific clinical procedure
Control1..1
BindingFor example codes, see ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures

Example ICD10 Procedure codes.

TypeChoice of: CodeableConcept, Reference(Procedure)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

This identifies the actual clinical procedure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
254. Claim.procedure:principal
Slice Nameprincipal
Definition

Procedures performed on the patient relevant to the billing items with the claim.

ShortPrincipal clinical procedure performedClinical procedures performed
Control0..1*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
256. Claim.procedure:principal.extension:serviceDescription
Slice NameserviceDescription
Definition

This extension is used to communicate a plain language description of the procedure, product, or service.

ShortService Description
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(Service Description) (Extension Type: string)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
258. Claim.procedure:principal.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
260. Claim.procedure:principal.sequence
Definition

A number to uniquely identify procedure entries.

ShortProcedure instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to claim details.

Pattern Value1
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
262. Claim.procedure:principal.type
Definition

When the condition was observed or the relative ranking.

ShortCategory of Procedure
Comments

For example: primary, secondary.

Control10..1*
BindingFor example codes, see ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type

Example procedure type codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;principal&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
264. Claim.procedure:principal.procedure[x]
Definition

The code or reference to a Procedure resource which identifies the clinical intervention performed.

ShortSpecific clinical procedure
Control1..1
BindingThe codes SHALL be taken from For example codes, see ICD-10 Procedure Codeshttp://hl7.org/fhir/ValueSet/icd-10-procedures
TypeCodeableConcept, Reference(Procedure)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

This identifies the actual clinical procedure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
266. Claim.procedure:other
Slice Nameother
Definition

Procedures performed on the patient relevant to the billing items with the claim.

ShortClinical procedures performed
Control0..24*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
268. Claim.procedure:other.extension:serviceDescription
Slice NameserviceDescription
Definition

This extension is used to communicate a plain language description of the procedure, product, or service.

ShortService Description
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(Service Description) (Extension Type: string)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
270. Claim.procedure:other.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
272. Claim.procedure:other.sequence
Definition

A number to uniquely identify procedure entries.

ShortProcedure instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
274. Claim.procedure:other.type
Definition

When the condition was observed or the relative ranking.

ShortCategory of Procedure
Comments

For example: primary, secondary.

Control10..1*
BindingFor example codes, see ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type

Example procedure type codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;other&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
276. Claim.procedure:other.procedure[x]
Definition

The code or reference to a Procedure resource which identifies the clinical intervention performed.

ShortSpecific clinical procedure
Control1..1
BindingThe codes SHALL be taken from For example codes, see PCT CMS HCPCS and AMA CPT Procedure Surgical Codeshttp://hl7.org/fhir/ValueSet/icd-10-procedures
TypeCodeableConcept, Reference(Procedure)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

This identifies the actual clinical procedure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
278. Claim.insurance
Definition

Financial instruments for reimbursement for the health care products and services specified on the claim.

ShortPatient insurance information
Comments

All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

Control1..*
TypeBackboneElement
Is Modifierfalse
Summarytrue
Requirements

At least one insurer is required for a claim to be a claim.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
280. Claim.insurance.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
282. Claim.insurance.sequence
Definition

A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.

ShortInsurance instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

To maintain order of the coverages.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
284. Claim.insurance.focal
Definition

A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

ShortCoverage to be used for adjudication
Comments

A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.

Control1..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

To identify which coverage in the list is being used to adjudicate this claim.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
286. Claim.insurance.coverage
Definition

Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

ShortInsurance information
Control1..1
TypeReference(PCT Coverage, Coverage)
Is Modifierfalse
Summarytrue
Requirements

Required to allow the adjudicator to locate the correct policy and history within their information system.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
288. Claim.insurance.preAuthRef
Definition

Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.

ShortPrior authorization reference number
Comments

This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.

Control0..1*
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
290. Claim.item
Definition

A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

ShortProduct or service provided
Control10..999*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

The items to be processed for adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
292. Claim.item.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control10..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.item.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
294. Claim.item.extension:gfeBillingProviderLineItemCtrlNum
Slice NamegfeBillingProviderLineItemCtrlNum
Definition

This extension is used by the provider to assign a unique identifier to this item. The intent of this element is to allow the provider to assign something other than 'line number' for their purposes (e.g. tracking and troubleshooting).

ShortExtension
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(GFEBillingProviderLineItemCtrlNum) (Extension Type: Identifier)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
296. Claim.item.extension:serviceDescription
Slice NameserviceDescription
Definition

This extension is used to communicate a plain language description of the procedure, product, or service.

ShortService Description
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(Service Description) (Extension Type: string)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
298. Claim.item.extension:ProviderEventMethodology
Slice NameProviderEventMethodology
Definition

This extension is used for indicating the method a provider used to group services, and those providing such services, beyond what may be indicated through DRGs that the payer or patient may find helpful (e.g. grouping services by a standardized episode of care definition). This is provider generated text and should not be modified by the payer.

ShortProvider Event Methodology
Comments

The method a provider used to group services. The extension definition contains additional detail

Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(ProviderEventMethodology) (Extension Type: string)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
300. Claim.item.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
302. Claim.item.sequence
Definition

A number to uniquely identify item entries.

ShortItem instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
304. Claim.item.revenue
Definition

The type of revenue or cost center providing the product and/or service.

ShortRevenue or cost center code - must provide a value for the Institutional case
Control10..1
BindingThe codes SHALL be taken from For example codes, see PCT GFE NUBC Revenue Value Sethttp://hl7.org/fhir/ValueSet/ex-revenue-center
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed in the processing of institutional claims.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
306. Claim.item.productOrService
Definition

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

ShortBilling, service, product, or drug code
Comments

Can include null or N/A or data absent reason for the In-Patient Institutional case.


If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Control1..1
BindingThe codes SHALL be taken from For example codes, see Claim Medical Product or Service Value Sethttp://hl7.org/fhir/ValueSet/service-uscls
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Necessary to state what was provided or done.

Alternate NamesDrug Code, Bill Code, Service Code
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
308. Claim.item.modifier
Definition

Item typification or modifiers codes to convey additional context for the product or service.

ShortProduct or service billing modifiers
Comments

For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

Control0..4*
BindingThe codes SHALL be taken from For example codes, see PCT GFE Item CPT - HCPCS Value Sethttp://hl7.org/fhir/ValueSet/claim-modifiers
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
310. Claim.item.serviced[x]
Definition

This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication


The date or dates when the service or product was supplied, performed or completed.

ShortThis is the planned or estimated date(s)s of serviceDate or dates of service or product delivery
Control10..1
TypeChoice of: date, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summaryfalse
Requirements

Needed to determine whether the service or product was provided during the term of the insurance coverage.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
312. Claim.item.location[x]
Definition

Where the product or service was provided.

ShortPlace of service or where product was supplied
Control0..1
BindingFor example codes, see ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-place

Place of service: pharmacy, school, prison, etc.

TypeChoice of: CodeableConcept, Address, Reference(Location)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.item.location[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
314. Claim.item.location[x]:locationCodeableConcept
Slice NamelocationCodeableConcept
Definition

Where the product or service was provided.

ShortPlace of service or where product was supplied
Control0..1
BindingThe codes SHALL be taken from For example codes, see PCT GFE CMS Place of Service Value Sethttp://hl7.org/fhir/ValueSet/service-place
TypeCodeableConcept, Address, Reference(Location)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
316. Claim.item.quantity
Definition

The number of repetitions of a service or product.

ShortCount of products or services
Control10..1
TypeQuantity(SimpleQuantity)
Is Modifierfalse
Summaryfalse
Requirements

Required when the product or service code does not convey the quantity provided.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
318. Claim.item.net
Definition

The quantity times the unit price for an additional service or product or charge.

ShortTotal charge amount for the service lineTotal item cost
Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control10..1
TypeMoney
Is Modifierfalse
Summaryfalse
Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
320. Claim.item.detail
Definition

A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

ShortDrug Identification InformationProduct or service provided
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The items to be processed for adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
322. Claim.item.detail.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
324. Claim.item.detail.sequence
Definition

A number to uniquely identify item entries.

ShortItem instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
326. Claim.item.detail.productOrService
Definition

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

ShortBilling, service, product, or drug code
Comments

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Control1..1
BindingThe codes SHALL be taken from For example codes, see PCT GFE Item NDC Value Sethttp://hl7.org/fhir/ValueSet/service-uscls
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Necessary to state what was provided or done.

Alternate NamesDrug Code, Bill Code, Service Code
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
328. Claim.item.detail.quantity
Definition

The number of repetitions of a service or product.

ShortCount of products or services
Control0..1
TypeQuantity(SimpleQuantity)
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required when the product or service code does not convey the quantity provided.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
330. Claim.total
Definition

The total value of the all the items in the claim.

ShortTotal GFE Charges SubmittedTotal claim cost
Control10..1
TypeMoney
Is Modifierfalse
Summaryfalse
Requirements

Used for control total purposes.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be found here

0. Claim
Definition

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

ShortClaim, Pre-determination or Pre-authorization
Comments

The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Claim.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

ShortLogical id of this artifact
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Control0..1
Typeid
Is Modifierfalse
Summarytrue
4. Claim.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Control0..1
TypeMeta
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Claim.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Claim.language
Definition

The base language in which the resource is written.

ShortLanguage of the resource content
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Control0..1
BindingThe codes SHOULD be taken from CommonLanguages

A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Claim.text
Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

ShortText summary of the resource, for human interpretation
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Control0..1
TypeNarrative
Is Modifierfalse
Summaryfalse
Alternate Namesnarrative, html, xhtml, display
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Claim.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Control0..*
TypeResource
Is Modifierfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
14. Claim.extension
Definition

An Extension

ShortExtension
Control1..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
16. Claim.extension:gfeSubmitter
Slice NamegfeSubmitter
Definition

This extension is used to indicate the scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB. All submitters (Practitioners and Organizations) must have an ETIN.

ShortThe scheduling entity that submits the GFE to provide a collection of services to a payer for the creation of an Advanced EOB
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(GFESubmitter) (Extension Type: Reference(PCT Organization, PCT Practitioner))
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
18. Claim.extension:gfeServiceLinkingInfo
Slice NamegfeServiceLinkingInfo
Definition

This extension is used to provide the GFE Service Linking Information. This allows implementers to have the same identifier on multiple GFEs that are part of one period of care's services. This would be needed for some of the workflow options that businesses may decide to use.

ShortGFE Service Linking Information.
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(GFEServiceLinkingInfo) (Complex Extension)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
20. Claim.extension:providerEventMethodology
Slice NameproviderEventMethodology
Definition

How the provider determined the number of claims and the number and type of billing providers to include in the GFE. Examples include provider episodes of care experience, PACES, order set based on clinical guidelines, payor suggested grouping, or some other method of determination. The extension deifnition contains additional detail.

ShortProvider event collection methodology
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(ProviderEventMethodology) (Extension Type: string)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
22. Claim.extension:gfeDisclaimer
Slice NamegfeDisclaimer
Definition

Disclaimers the patient should be made aware of regarding the providers estimate

ShortDisclaimers the patient should be made aware of regarding the providers estimate
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(GFEDisclaimer) (Extension Type: string)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
24. Claim.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
26. Claim.identifier
Definition

A unique identifier assigned to this claim.

ShortBusiness Identifier for claim
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..*
TypeIdentifier
Is Modifierfalse
Summaryfalse
Requirements

Allows claims to be distinguished and referenced.

Alternate NamesClaim Number
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
28. Claim.identifier:PLAC
Slice NamePLAC
Definition

A unique identifier assigned to this claim.

ShortProvider Assigned Identifier for GFE Claim
NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1
TypeIdentifier
Is Modifierfalse
Summaryfalse
Requirements

Allows claims to be distinguished and referenced.

Alternate NamesClaim Number
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Claim.identifier:PLAC.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
32. Claim.identifier:PLAC.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
34. Claim.identifier:PLAC.use
Definition

The purpose of this identifier.

Shortusual | official | temp | secondary | old (If known)
Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue because This is labeled as &quot;Is Modifier&quot; because applications should not mistake a temporary id for a permanent one.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. Claim.identifier:PLAC.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

ShortDescription of identifier
Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Control1..1
BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/v2-0203&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;PLAC&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;display&nbsp;value=&quot;Placer&nbsp;Identifier&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. Claim.identifier:PLAC.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

ShortThe namespace for the identifier value
Comments

Identifier.system is always case sensitive.

Control0..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. Claim.identifier:PLAC.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

ShortThe value that is unique
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control1..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Example<br/><b>General</b>:123456
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. Claim.identifier:PLAC.period
Definition

Time period during which identifier is/was valid for use.

ShortTime period when id is/was valid for use
Control0..1
TypePeriod
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
44. Claim.identifier:PLAC.assigner
Definition

Organization that issued/manages the identifier.

ShortOrganization that issued id (may be just text)
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control0..1
TypeReference(Organization)
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
46. Claim.identifier:INTER
Slice NameINTER
Definition

A unique identifier assigned to this claim.

ShortIntermediary System Identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Is Modifierfalse
Summaryfalse
Requirements

Allows claims to be distinguished and referenced.

Alternate NamesClaim Number
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
48. Claim.identifier:INTER.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
50. Claim.identifier:INTER.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
52. Claim.identifier:INTER.use
Definition

The purpose of this identifier.

Shortusual | official | temp | secondary | old (If known)
Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue because This is labeled as &quot;Is Modifier&quot; because applications should not mistake a temporary id for a permanent one.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. Claim.identifier:INTER.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

ShortDescription of identifier
Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Control1..1
BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;INTER&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;display&nbsp;value=&quot;Intermediary&nbsp;System&nbsp;Identifier&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
56. Claim.identifier:INTER.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

ShortThe namespace for the identifier value
Comments

Identifier.system is always case sensitive.

Control0..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
58. Claim.identifier:INTER.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

ShortThe value that is unique
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Example<br/><b>General</b>:123456
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
60. Claim.identifier:INTER.period
Definition

Time period during which identifier is/was valid for use.

ShortTime period when id is/was valid for use
Control0..1
TypePeriod
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
62. Claim.identifier:INTER.assigner
Definition

Organization that issued/manages the identifier.

ShortOrganization that issued id (may be just text)
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control0..1
TypeReference(Organization)
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
64. Claim.status
Definition

The status of the resource instance.

Shortactive | cancelled | draft | entered-in-error
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Control1..1
BindingThe codes SHALL be taken from FinancialResourceStatusCodes

A code specifying the state of the resource instance.

Typecode
Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. Claim.type
Definition

The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

ShortCategory or discipline
Comments

The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.

Control1..1
BindingUnless not suitable, these codes SHALL be taken from ClaimTypeCodes

The type or discipline-style of the claim.

TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

Claim type determine the general sets of business rules applied for information requirements and adjudication.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/claim-type&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;institutional&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
68. Claim.subType
Definition

A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

ShortMore granular claim type
Comments

This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

Control0..1
BindingFor example codes, see ExampleClaimSubTypeCodes

A more granular claim typecode.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Some jurisdictions need a finer grained claim type for routing and adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
70. Claim.use
Definition

A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

Shortclaim | preauthorization | predetermination
Control1..1
BindingThe codes SHALL be taken from Use

The purpose of the Claim: predetermination, preauthorization, claim.

Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

This element is required to understand the nature of the request for adjudication.

Pattern Valuepredetermination
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
72. Claim.patient
Definition

The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

ShortThe recipient of the products and services
Control1..1
TypeReference(HRex Patient Demographics)
Is Modifierfalse
Summarytrue
Requirements

The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
74. Claim.billablePeriod
Definition

The period for which charges are being submitted.

ShortRelevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
Comments

Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.

Control0..1
TypePeriod
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
76. Claim.created
Definition

The date this resource was created.

ShortResource creation date
Comments

This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

Control1..1
TypedateTime
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to record a timestamp for use by both the recipient and the issuer.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
78. Claim.enterer
Definition

Individual who created the claim, predetermination or preauthorization.

ShortAuthor of the claim
Control0..1
TypeReference(Practitioner, PractitionerRole)
Is Modifierfalse
Summaryfalse
Requirements

Some jurisdictions require the contact information for personnel completing claims.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
80. Claim.insurer
Definition

The Insurer who is target of the request.

ShortTarget
Control1..1
TypeReference(PCT Organization)
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
82. Claim.provider
Definition

The provider which is responsible for the claim, predetermination or preauthorization.

ShortBilling provider - party responsible for the GFE
Comments

Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

Control1..1
TypeReference(PCT Organization)
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
84. Claim.provider.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
86. Claim.provider.extension
Definition

An Extension

ShortExtension
Control1..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.provider.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
88. Claim.provider.extension:providerTaxonomy
Slice NameproviderTaxonomy
Definition

This extension is used to indicate the taxonomy code of the provider.

ShortProvider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
Control1..1
TypeExtension(ProviderTaxonomy) (Extension Type: CodeableConcept)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
90. Claim.provider.extension:consentForBalanceBilling
Slice NameconsentForBalanceBilling
Definition

If the provider has received a written consent form indicating a patient has agreed to waive their protections and pay up to the full cost for the out-of-network item or service, this will be “true”. If the provider has not received written consent, this will be “false”. This is an attestation only. The billing provider is legally required to maintain the written notice and consent form.

ShortExtension
Control0..1
TypeExtension(GFEConsentForBalanceBilling) (Extension Type: boolean)
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
92. Claim.provider.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

ShortLiteral reference, Relative, internal or absolute URL
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Control0..1
This element is affected by the following invariants: ref-1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
94. Claim.provider.type
Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

ShortType the reference refers to (e.g. "Patient")
Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Control0..1
BindingUnless not suitable, these codes SHALL be taken from ResourceType

Aa resource (or, for logical models, the URI of the logical model).

Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
96. Claim.provider.identifier
Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

ShortLogical reference, when literal reference is not known
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
98. Claim.provider.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

ShortText alternative for the resource
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
100. Claim.priority
Definition

The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

ShortDesired processing ugency
Comments

If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.

Control1..1
BindingThe codes SHALL be taken from ProcessPriorityCodes
TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
102. Claim.fundsReserve
Definition

A code to indicate whether and for whom funds are to be reserved for future claims.

ShortFor whom to reserve funds
Comments

This field is only used for preauthorizations.

Control0..1
BindingFor example codes, see Funds Reservation Codes

For whom funds are to be reserved: (Patient, Provider, None).

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

Alternate NamesFund pre-allocation
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
104. Claim.related
Definition

Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

ShortPrior or corollary claims
Comments

For example, for the original treatment and follow-up exams.

Control0..*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

For workplace or other accidents it is common to relate separate claims arising from the same event.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
106. Claim.related.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
108. Claim.related.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
110. Claim.related.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
112. Claim.related.claim
Definition

Reference to a related claim.

ShortReference to the related claim
Control0..1
TypeReference(Claim)
Is Modifierfalse
Summaryfalse
Requirements

For workplace or other accidents it is common to relate separate claims arising from the same event.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
114. Claim.related.relationship
Definition

A code to convey how the claims are related.

ShortHow the reference claim is related
Comments

For example, prior claim or umbrella.

Control0..1
BindingFor example codes, see ExampleRelatedClaimRelationshipCodes

Relationship of this claim to a related Claim.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Some insurers need a declaration of the type of relationship.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
116. Claim.related.reference
Definition

An alternate organizational reference to the case or file to which this particular claim pertains.

ShortFile or case reference
Comments

For example, Property/Casualty insurer claim # or Workers Compensation case # .

Control0..1
TypeIdentifier
Is Modifierfalse
Summaryfalse
Requirements

In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
118. Claim.prescription
Definition

Prescription to support the dispensing of pharmacy, device or vision products.

ShortPrescription authorizing services and products
Control0..1
TypeReference(DeviceRequest, MedicationRequest, VisionPrescription)
Is Modifierfalse
Summaryfalse
Requirements

Required to authorize the dispensing of controlled substances and devices.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
120. Claim.originalPrescription
Definition

Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

ShortOriginal prescription if superseded by fulfiller
Comments

For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

Control0..1
TypeReference(DeviceRequest, MedicationRequest, VisionPrescription)
Is Modifierfalse
Summaryfalse
Requirements

Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
122. Claim.payee
Definition

The party to be reimbursed for cost of the products and services according to the terms of the policy.

ShortRecipient of benefits payable
Comments

Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead.

Control0..1
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
124. Claim.payee.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
126. Claim.payee.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
128. Claim.payee.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
130. Claim.payee.type
Definition

Type of Party to be reimbursed: subscriber, provider, other.

ShortCategory of recipient
Control1..1
BindingFor example codes, see Claim Payee Type Codes

A code for the party to be reimbursed.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
132. Claim.payee.party
Definition

Reference to the individual or organization to whom any payment will be made.

ShortRecipient reference
Comments

Not required if the payee is 'subscriber' or 'provider'.

Control0..1
TypeReference(PCT Practitioner, PCT Organization)
Is Modifierfalse
Summaryfalse
Requirements

Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
134. Claim.referral
Definition

A reference to a referral resource.

ShortTreatment referral
Comments

The referral resource which lists the date, practitioner, reason and other supporting information.

Control0..1
TypeReference(ServiceRequest)
Is Modifierfalse
Summaryfalse
Requirements

Some insurers require proof of referral to pay for services or to pay specialist rates for services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
136. Claim.referral.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
138. Claim.referral.extension
Definition

An Extension

ShortExtension
Control1..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.referral.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
140. Claim.referral.extension:referralNumber
Slice NamereferralNumber
Definition

This extension is used to provide the Referral Number.

ShortReferral Number
Control1..1
TypeExtension(ReferralNumber) (Extension Type: string)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
142. Claim.referral.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

ShortLiteral reference, Relative, internal or absolute URL
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Control0..1
This element is affected by the following invariants: ref-1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
144. Claim.referral.type
Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

ShortType the reference refers to (e.g. "Patient")
Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Control0..1
BindingUnless not suitable, these codes SHALL be taken from ResourceType

Aa resource (or, for logical models, the URI of the logical model).

Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
146. Claim.referral.identifier
Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

ShortLogical reference, when literal reference is not known
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
148. Claim.referral.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

ShortText alternative for the resource
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
150. Claim.facility
Definition

Facility where the services were provided.

ShortServicing facility
Control0..1
TypeReference(Location)
Is Modifierfalse
Summaryfalse
Requirements

Insurance adjudication can be dependant on where services were delivered.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
152. Claim.careTeam
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.careTeam. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ role
154. Claim.careTeam.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
156. Claim.careTeam.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
158. Claim.careTeam.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
160. Claim.careTeam.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
162. Claim.careTeam.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(PCT Practitioner, PCT Organization)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
164. Claim.careTeam.responsible
Definition

The party who is billing and/or responsible for the claimed products or services.

ShortIndicator of the lead practitioner
Comments

Responsible might not be required when there is only a single provider listed.

Control0..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the lead or responsible individual.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
166. Claim.careTeam.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control1..1
BindingThe codes SHALL be taken from PCT Care Team Role Value Set
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
168. Claim.careTeam.qualification
Definition

The qualification of the practitioner which is applicable for this service.

ShortPractitioner credential or specialization
Control0..1
BindingThe codes SHALL be taken from US Core Provider Role (NUCC)
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to specify which qualification a provider is delivering the product or service under.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
170. Claim.careTeam:attending
Slice Nameattending
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..1
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
172. Claim.careTeam:attending.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
174. Claim.careTeam:attending.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
176. Claim.careTeam:attending.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
178. Claim.careTeam:attending.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
180. Claim.careTeam:attending.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(PCT Practitioner)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
182. Claim.careTeam:attending.responsible
Definition

The party who is billing and/or responsible for the claimed products or services.

ShortIndicator of the lead practitioner
Comments

Responsible might not be required when there is only a single provider listed.

Control0..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the lead or responsible individual.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
184. Claim.careTeam:attending.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control0..1
BindingFor example codes, see ClaimCareTeamRoleCodes

The role codes for the care team members.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;attending&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
186. Claim.careTeam:attending.qualification
Definition

The qualification of the practitioner which is applicable for this service.

ShortPractitioner credential or specialization
Control1..1
BindingFor example codes, see ExampleProviderQualificationCodes

Provider professional qualifications.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to specify which qualification a provider is delivering the product or service under.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
188. Claim.careTeam:operating
Slice Nameoperating
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..2
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
190. Claim.careTeam:operating.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
192. Claim.careTeam:operating.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
194. Claim.careTeam:operating.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
196. Claim.careTeam:operating.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
198. Claim.careTeam:operating.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(PCT Practitioner)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
200. Claim.careTeam:operating.responsible
Definition

The party who is billing and/or responsible for the claimed products or services.

ShortIndicator of the lead practitioner
Comments

Responsible might not be required when there is only a single provider listed.

Control0..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the lead or responsible individual.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
202. Claim.careTeam:operating.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control0..1
BindingFor example codes, see ClaimCareTeamRoleCodes

The role codes for the care team members.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;operating&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
204. Claim.careTeam:operating.qualification
Definition

The qualification of the practitioner which is applicable for this service.

ShortPractitioner credential or specialization
Control0..1
BindingFor example codes, see ExampleProviderQualificationCodes

Provider professional qualifications.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to specify which qualification a provider is delivering the product or service under.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
206. Claim.careTeam:rendering
Slice Namerendering
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..1
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
208. Claim.careTeam:rendering.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
210. Claim.careTeam:rendering.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
212. Claim.careTeam:rendering.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
214. Claim.careTeam:rendering.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
216. Claim.careTeam:rendering.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(PCT Practitioner)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
218. Claim.careTeam:rendering.responsible
Definition

The party who is billing and/or responsible for the claimed products or services.

ShortIndicator of the lead practitioner
Comments

Responsible might not be required when there is only a single provider listed.

Control0..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the lead or responsible individual.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
220. Claim.careTeam:rendering.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control0..1
BindingFor example codes, see ClaimCareTeamRoleCodes

The role codes for the care team members.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;rendering&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
222. Claim.careTeam:rendering.qualification
Definition

The qualification of the practitioner which is applicable for this service.

ShortPractitioner credential or specialization
Control0..1
BindingFor example codes, see ExampleProviderQualificationCodes

Provider professional qualifications.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to specify which qualification a provider is delivering the product or service under.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
224. Claim.careTeam:referring
Slice Namereferring
Definition

The members of the team who provided the products and services.

ShortMembers of the care team
Control0..1
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Common to identify the responsible and supporting practitioners.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
226. Claim.careTeam:referring.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
228. Claim.careTeam:referring.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
230. Claim.careTeam:referring.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
232. Claim.careTeam:referring.sequence
Definition

A number to uniquely identify care team entries.

ShortOrder of care team
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
234. Claim.careTeam:referring.provider
Definition

Member of the team who provided the product or service.

ShortPractitioner or organization
Control1..1
TypeReference(Practitioner, PractitionerRole, Organization)
Is Modifierfalse
Summaryfalse
Requirements

Often a regulatory requirement to specify the responsible provider.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
236. Claim.careTeam:referring.responsible
Definition

The party who is billing and/or responsible for the claimed products or services.

ShortIndicator of the lead practitioner
Comments

Responsible might not be required when there is only a single provider listed.

Control0..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the lead or responsible individual.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
238. Claim.careTeam:referring.role
Definition

The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

ShortFunction within the team
Comments

Role might not be required when there is only a single provider listed.

Control0..1
BindingFor example codes, see ClaimCareTeamRoleCodes

The role codes for the care team members.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;referring&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
240. Claim.careTeam:referring.qualification
Definition

The qualification of the practitioner which is applicable for this service.

ShortPractitioner credential or specialization
Control0..1
BindingFor example codes, see ExampleProviderQualificationCodes

Provider professional qualifications.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Need to specify which qualification a provider is delivering the product or service under.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
242. Claim.supportingInfo
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control1..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.supportingInfo. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ category
244. Claim.supportingInfo.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
246. Claim.supportingInfo.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
248. Claim.supportingInfo.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
250. Claim.supportingInfo.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
252. Claim.supportingInfo.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingUnless not suitable, these codes SHALL be taken from PCT Supporting Info Type Value Set
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
254. Claim.supportingInfo.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control0..1
BindingFor example codes, see ExceptionCodes

The valuset used for additional information codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
256. Claim.supportingInfo.timing[x]
Definition

The date when or period to which this information refers.

ShortWhen it occurred
Control0..1
TypeChoice of: date, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
258. Claim.supportingInfo.value[x]
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

ShortData to be provided
Comments

Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

Control0..1
TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
260. Claim.supportingInfo.reason
Definition

Provides the reason in the situation where a reason code is required in addition to the content.

ShortExplanation for the information
Comments

For example: the reason for the additional stay, or why a tooth is missing.

Control0..1
BindingFor example codes, see MissingToothReasonCodes

Reason codes for the missing teeth.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed when the supporting information has both a date and amount/value and requires explanation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
262. Claim.supportingInfo:typeOfBill
Slice NametypeOfBill
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control1..1
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
264. Claim.supportingInfo:typeOfBill.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
266. Claim.supportingInfo:typeOfBill.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
268. Claim.supportingInfo:typeOfBill.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
270. Claim.supportingInfo:typeOfBill.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
272. Claim.supportingInfo:typeOfBill.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodes

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;typeofbill&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
274. Claim.supportingInfo:typeOfBill.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control1..1
BindingThe codes SHALL be taken from PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
276. Claim.supportingInfo:typeOfBill.timing[x]
Definition

The date when or period to which this information refers.

ShortWhen it occurred
Control0..1
TypeChoice of: date, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
278. Claim.supportingInfo:typeOfBill.value[x]
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

ShortData to be provided
Comments

Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

Control0..1
TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
280. Claim.supportingInfo:typeOfBill.reason
Definition

Provides the reason in the situation where a reason code is required in addition to the content.

ShortExplanation for the information
Comments

For example: the reason for the additional stay, or why a tooth is missing.

Control0..1
BindingFor example codes, see MissingToothReasonCodes

Reason codes for the missing teeth.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed when the supporting information has both a date and amount/value and requires explanation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
282. Claim.supportingInfo:serviceFacility
Slice NameserviceFacility
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortService Facility
Comments

Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider.

Control0..1
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
284. Claim.supportingInfo:serviceFacility.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
286. Claim.supportingInfo:serviceFacility.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
288. Claim.supportingInfo:serviceFacility.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
290. Claim.supportingInfo:serviceFacility.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
292. Claim.supportingInfo:serviceFacility.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodes

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;servicefacility&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
294. Claim.supportingInfo:serviceFacility.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control0..1
BindingFor example codes, see ExceptionCodes

The valuset used for additional information codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
296. Claim.supportingInfo:serviceFacility.timing[x]
Definition

The date when or period to which this information refers.

ShortWhen it occurred
Control0..1
TypeChoice of: date, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
298. Claim.supportingInfo:serviceFacility.value[x]
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

ShortData to be provided
Comments

Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

Control1..1
TypeReference(Resource)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
300. Claim.supportingInfo:serviceFacility.value[x]:valueReference
Slice NamevalueReference
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

ShortData to be provided
Comments

Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

Control1..1
TypeReference(PCT Organization)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
302. Claim.supportingInfo:serviceFacility.reason
Definition

Provides the reason in the situation where a reason code is required in addition to the content.

ShortExplanation for the information
Comments

For example: the reason for the additional stay, or why a tooth is missing.

Control0..1
BindingFor example codes, see MissingToothReasonCodes

Reason codes for the missing teeth.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed when the supporting information has both a date and amount/value and requires explanation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
304. Claim.supportingInfo:drg
Slice Namedrg
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control0..1
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
306. Claim.supportingInfo:drg.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
308. Claim.supportingInfo:drg.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
310. Claim.supportingInfo:drg.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
312. Claim.supportingInfo:drg.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
314. Claim.supportingInfo:drg.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodes

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;drg&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
316. Claim.supportingInfo:drg.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control0..1
BindingThe codes SHALL be taken from US Claim DRG Codes
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
318. Claim.supportingInfo:drg.timing[x]
Definition

The date when or period to which this information refers.

ShortWhen it occurred
Control0..1
TypeChoice of: date, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
320. Claim.supportingInfo:drg.value[x]
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

ShortData to be provided
Comments

Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

Control0..1
TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
322. Claim.supportingInfo:drg.reason
Definition

Provides the reason in the situation where a reason code is required in addition to the content.

ShortExplanation for the information
Comments

For example: the reason for the additional stay, or why a tooth is missing.

Control0..1
BindingFor example codes, see MissingToothReasonCodes

Reason codes for the missing teeth.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed when the supporting information has both a date and amount/value and requires explanation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
324. Claim.supportingInfo:pointoforigin
Slice Namepointoforigin
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control0..1
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
326. Claim.supportingInfo:pointoforigin.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
328. Claim.supportingInfo:pointoforigin.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
330. Claim.supportingInfo:pointoforigin.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
332. Claim.supportingInfo:pointoforigin.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
334. Claim.supportingInfo:pointoforigin.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodes

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;pointoforigin&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
336. Claim.supportingInfo:pointoforigin.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control0..1
BindingThe codes SHALL be taken from NUBC Point Of Origin
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
338. Claim.supportingInfo:pointoforigin.timing[x]
Definition

The date when or period to which this information refers.

ShortWhen it occurred
Control0..1
TypeChoice of: date, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
340. Claim.supportingInfo:pointoforigin.value[x]
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

ShortData to be provided
Comments

Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

Control0..1
TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
342. Claim.supportingInfo:pointoforigin.reason
Definition

Provides the reason in the situation where a reason code is required in addition to the content.

ShortExplanation for the information
Comments

For example: the reason for the additional stay, or why a tooth is missing.

Control0..1
BindingFor example codes, see MissingToothReasonCodes

Reason codes for the missing teeth.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed when the supporting information has both a date and amount/value and requires explanation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
344. Claim.supportingInfo:admtype
Slice Nameadmtype
Definition

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

ShortSupporting information
Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control0..1
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
346. Claim.supportingInfo:admtype.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
348. Claim.supportingInfo:admtype.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
350. Claim.supportingInfo:admtype.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
352. Claim.supportingInfo:admtype.sequence
Definition

A number to uniquely identify supporting information entries.

ShortInformation instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
354. Claim.supportingInfo:admtype.category
Definition

The general class of the information supplied: information; exception; accident, employment; onset, etc.

ShortClassification of the supplied information
Comments

This may contain a category for the local bill type codes.

Control1..1
BindingFor example codes, see ClaimInformationCategoryCodes

The valuset used for additional information category codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;admtype&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
356. Claim.supportingInfo:admtype.code
Definition

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

ShortType of information
Control0..1
BindingThe codes SHALL be taken from NUBC Priority (Type) of Admission or Visit
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to identify the kind of additional information.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
358. Claim.supportingInfo:admtype.timing[x]
Definition

The date when or period to which this information refers.

ShortWhen it occurred
Control0..1
TypeChoice of: date, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
360. Claim.supportingInfo:admtype.value[x]
Definition

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

ShortData to be provided
Comments

Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

Control0..1
TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
362. Claim.supportingInfo:admtype.reason
Definition

Provides the reason in the situation where a reason code is required in addition to the content.

ShortExplanation for the information
Comments

For example: the reason for the additional stay, or why a tooth is missing.

Control0..1
BindingFor example codes, see MissingToothReasonCodes

Reason codes for the missing teeth.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed when the supporting information has both a date and amount/value and requires explanation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
364. Claim.diagnosis
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control1..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.diagnosis. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
366. Claim.diagnosis.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
368. Claim.diagnosis.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
370. Claim.diagnosis.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
372. Claim.diagnosis.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
374. Claim.diagnosis.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingFor example codes, see ICD-10Codes

Example ICD10 Diagnostic codes.

TypeChoice of: CodeableConcept, Reference(Condition)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
376. Claim.diagnosis.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control0..*
BindingThe codes SHALL be taken from PCT Diagnosis Type Value Set
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
378. Claim.diagnosis.onAdmission
Definition

Indication of whether the diagnosis was present on admission to a facility.

ShortPresent on admission
Control0..1
BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes

Present on admission.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Many systems need to understand for adjudication if the diagnosis was present a time of admission.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
380. Claim.diagnosis.packageCode
Definition

A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

ShortPackage billing code
Comments

For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

Control0..1
BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes

The DRG codes associated with the diagnosis.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
382. Claim.diagnosis:principal
Slice Nameprincipal
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control1..1
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
384. Claim.diagnosis:principal.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
386. Claim.diagnosis:principal.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
388. Claim.diagnosis:principal.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
390. Claim.diagnosis:principal.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Pattern Value1
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
392. Claim.diagnosis:principal.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
394. Claim.diagnosis:principal.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control1..1
BindingFor example codes, see ExampleDiagnosisTypeCodes

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/ex-diagnosistype&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;principal&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
396. Claim.diagnosis:principal.onAdmission
Definition

Indication of whether the diagnosis was present on admission to a facility.

ShortPresent on admission
Control0..1
BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes

Present on admission.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Many systems need to understand for adjudication if the diagnosis was present a time of admission.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
398. Claim.diagnosis:principal.packageCode
Definition

A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

ShortPackage billing code
Comments

For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

Control0..1
BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes

The DRG codes associated with the diagnosis.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
400. Claim.diagnosis:admitting
Slice Nameadmitting
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control0..1
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
402. Claim.diagnosis:admitting.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
404. Claim.diagnosis:admitting.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
406. Claim.diagnosis:admitting.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
408. Claim.diagnosis:admitting.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
410. Claim.diagnosis:admitting.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
412. Claim.diagnosis:admitting.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control1..1
BindingFor example codes, see ExampleDiagnosisTypeCodes

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://terminology.hl7.org/CodeSystem/ex-diagnosistype&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;admitting&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
414. Claim.diagnosis:admitting.onAdmission
Definition

Indication of whether the diagnosis was present on admission to a facility.

ShortPresent on admission
Control0..1
BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes

Present on admission.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Many systems need to understand for adjudication if the diagnosis was present a time of admission.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
416. Claim.diagnosis:admitting.packageCode
Definition

A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

ShortPackage billing code
Comments

For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

Control0..1
BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes

The DRG codes associated with the diagnosis.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
418. Claim.diagnosis:patientReasonForVisit
Slice NamepatientReasonForVisit
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control0..3
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
420. Claim.diagnosis:patientReasonForVisit.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
422. Claim.diagnosis:patientReasonForVisit.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
424. Claim.diagnosis:patientReasonForVisit.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
426. Claim.diagnosis:patientReasonForVisit.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
428. Claim.diagnosis:patientReasonForVisit.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
430. Claim.diagnosis:patientReasonForVisit.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control1..1
BindingFor example codes, see ExampleDiagnosisTypeCodes

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;patientReasonForVisit&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
432. Claim.diagnosis:patientReasonForVisit.onAdmission
Definition

Indication of whether the diagnosis was present on admission to a facility.

ShortPresent on admission
Control0..1
BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes

Present on admission.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Many systems need to understand for adjudication if the diagnosis was present a time of admission.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
434. Claim.diagnosis:patientReasonForVisit.packageCode
Definition

A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

ShortPackage billing code
Comments

For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

Control0..1
BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes

The DRG codes associated with the diagnosis.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
436. Claim.diagnosis:externalcauseofinjury
Slice Nameexternalcauseofinjury
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control0..12
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
438. Claim.diagnosis:externalcauseofinjury.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
440. Claim.diagnosis:externalcauseofinjury.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
442. Claim.diagnosis:externalcauseofinjury.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
444. Claim.diagnosis:externalcauseofinjury.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
446. Claim.diagnosis:externalcauseofinjury.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
448. Claim.diagnosis:externalcauseofinjury.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control1..1
BindingFor example codes, see ExampleDiagnosisTypeCodes

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;externalCauseOfInjury&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
450. Claim.diagnosis:externalcauseofinjury.onAdmission
Definition

Indication of whether the diagnosis was present on admission to a facility.

ShortPresent on admission
Control0..1
BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes

Present on admission.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Many systems need to understand for adjudication if the diagnosis was present a time of admission.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
452. Claim.diagnosis:externalcauseofinjury.packageCode
Definition

A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

ShortPackage billing code
Comments

For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

Control0..1
BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes

The DRG codes associated with the diagnosis.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
454. Claim.diagnosis:other
Slice Nameother
Definition

Information about diagnoses relevant to the claim items.

ShortPertinent diagnosis information
Control0..24
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required for the adjudication by provided context for the services and product listed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
456. Claim.diagnosis:other.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
458. Claim.diagnosis:other.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
460. Claim.diagnosis:other.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
462. Claim.diagnosis:other.sequence
Definition

A number to uniquely identify diagnosis entries.

ShortDiagnosis instance identifier
Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
464. Claim.diagnosis:other.diagnosis[x]
Definition

The nature of illness or problem in a coded form or as a reference to an external defined Condition.

ShortNature of illness or problem
Control1..1
BindingThe codes SHALL be taken from PCT ICD-10 Diagnostic Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Provides health context for the evaluation of the products and/or services.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
466. Claim.diagnosis:other.type
Definition

When the condition was observed or the relative ranking.

ShortTiming or nature of the diagnosis
Comments

For example: admitting, primary, secondary, discharge.

Control1..1
BindingFor example codes, see ExampleDiagnosisTypeCodes

The type of the diagnosis: admitting, principal, discharge.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;other&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
468. Claim.diagnosis:other.onAdmission
Definition

Indication of whether the diagnosis was present on admission to a facility.

ShortPresent on admission
Control0..1
BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes

Present on admission.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Many systems need to understand for adjudication if the diagnosis was present a time of admission.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
470. Claim.diagnosis:other.packageCode
Definition

A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

ShortPackage billing code
Comments

For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

Control0..1
BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes

The DRG codes associated with the diagnosis.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
472. Claim.procedure
Definition

Procedures performed on the patient relevant to the billing items with the claim.

ShortClinical procedures performed
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.procedure. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ type
474. Claim.procedure.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
476. Claim.procedure.extension
Definition

An Extension

ShortExtension
Control1..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
478. Claim.procedure.extension:serviceDescription
Slice NameserviceDescription
Definition

This extension is used to communicate a plain language description of the procedure, product, or service.

ShortService Description
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(Service Description) (Extension Type: string)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
480. Claim.procedure.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
482. Claim.procedure.sequence
Definition

A number to uniquely identify procedure entries.

ShortProcedure instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
484. Claim.procedure.type
Definition

When the condition was observed or the relative ranking.

ShortCategory of Procedure
Comments

For example: primary, secondary.

Control0..*
BindingThe codes SHALL be taken from PCT Procedure Type Value Set
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
486. Claim.procedure.date
Definition

Date and optionally time the procedure was performed.

ShortWhen the procedure was performed
Control0..1
TypedateTime
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Required for auditing purposes.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
488. Claim.procedure.procedure[x]
Definition

The code or reference to a Procedure resource which identifies the clinical intervention performed.

ShortSpecific clinical procedure
Control1..1
BindingFor example codes, see ICD-10ProcedureCodes

Example ICD10 Procedure codes.

TypeChoice of: CodeableConcept, Reference(Procedure)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

This identifies the actual clinical procedure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
490. Claim.procedure.udi
Definition

Unique Device Identifiers associated with this line item.

ShortUnique device identifier
Control0..*
TypeReference(Device)
Is Modifierfalse
Summaryfalse
Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
492. Claim.procedure:principal
Slice Nameprincipal
Definition

Procedures performed on the patient relevant to the billing items with the claim.

ShortPrincipal clinical procedure performed
Control0..1
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
494. Claim.procedure:principal.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
496. Claim.procedure:principal.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
498. Claim.procedure:principal.extension:serviceDescription
Slice NameserviceDescription
Definition

This extension is used to communicate a plain language description of the procedure, product, or service.

ShortService Description
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(Service Description) (Extension Type: string)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
500. Claim.procedure:principal.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
502. Claim.procedure:principal.sequence
Definition

A number to uniquely identify procedure entries.

ShortProcedure instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to claim details.

Pattern Value1
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
504. Claim.procedure:principal.type
Definition

When the condition was observed or the relative ranking.

ShortCategory of Procedure
Comments

For example: primary, secondary.

Control1..1
BindingFor example codes, see ExampleProcedureTypeCodes

Example procedure type codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;principal&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
506. Claim.procedure:principal.date
Definition

Date and optionally time the procedure was performed.

ShortWhen the procedure was performed
Control0..1
TypedateTime
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Required for auditing purposes.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
508. Claim.procedure:principal.procedure[x]
Definition

The code or reference to a Procedure resource which identifies the clinical intervention performed.

ShortSpecific clinical procedure
Control1..1
BindingThe codes SHALL be taken from ICD-10 Procedure Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

This identifies the actual clinical procedure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
510. Claim.procedure:principal.udi
Definition

Unique Device Identifiers associated with this line item.

ShortUnique device identifier
Control0..*
TypeReference(Device)
Is Modifierfalse
Summaryfalse
Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
512. Claim.procedure:other
Slice Nameother
Definition

Procedures performed on the patient relevant to the billing items with the claim.

ShortClinical procedures performed
Control0..24
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
514. Claim.procedure:other.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
516. Claim.procedure:other.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
518. Claim.procedure:other.extension:serviceDescription
Slice NameserviceDescription
Definition

This extension is used to communicate a plain language description of the procedure, product, or service.

ShortService Description
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(Service Description) (Extension Type: string)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
520. Claim.procedure:other.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
522. Claim.procedure:other.sequence
Definition

A number to uniquely identify procedure entries.

ShortProcedure instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to claim details.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
524. Claim.procedure:other.type
Definition

When the condition was observed or the relative ranking.

ShortCategory of Procedure
Comments

For example: primary, secondary.

Control1..1
BindingFor example codes, see ExampleProcedureTypeCodes

Example procedure type codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;other&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
526. Claim.procedure:other.date
Definition

Date and optionally time the procedure was performed.

ShortWhen the procedure was performed
Control0..1
TypedateTime
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Required for auditing purposes.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
528. Claim.procedure:other.procedure[x]
Definition

The code or reference to a Procedure resource which identifies the clinical intervention performed.

ShortSpecific clinical procedure
Control1..1
BindingThe codes SHALL be taken from PCT CMS HCPCS and AMA CPT Procedure Surgical Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

This identifies the actual clinical procedure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
530. Claim.procedure:other.udi
Definition

Unique Device Identifiers associated with this line item.

ShortUnique device identifier
Control0..*
TypeReference(Device)
Is Modifierfalse
Summaryfalse
Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
532. Claim.insurance
Definition

Financial instruments for reimbursement for the health care products and services specified on the claim.

ShortPatient insurance information
Comments

All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

Control1..*
TypeBackboneElement
Is Modifierfalse
Summarytrue
Requirements

At least one insurer is required for a claim to be a claim.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
534. Claim.insurance.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
536. Claim.insurance.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
538. Claim.insurance.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
540. Claim.insurance.sequence
Definition

A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.

ShortInsurance instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

To maintain order of the coverages.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
542. Claim.insurance.focal
Definition

A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

ShortCoverage to be used for adjudication
Comments

A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.

Control1..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

To identify which coverage in the list is being used to adjudicate this claim.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
544. Claim.insurance.identifier
Definition

The business identifier to be used when the claim is sent for adjudication against this insurance policy.

ShortPre-assigned Claim number
Comments

Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Is Modifierfalse
Summaryfalse
Requirements

This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
546. Claim.insurance.coverage
Definition

Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

ShortInsurance information
Control1..1
TypeReference(PCT Coverage)
Is Modifierfalse
Summarytrue
Requirements

Required to allow the adjudicator to locate the correct policy and history within their information system.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
548. Claim.insurance.businessArrangement
Definition

A business agreement number established between the provider and the insurer for special business processing purposes.

ShortAdditional provider contract number
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
550. Claim.insurance.preAuthRef
Definition

Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.

ShortPrior authorization reference number
Comments

This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
552. Claim.insurance.claimResponse
Definition

The result of the adjudication of the line items for the Coverage specified in this insurance.

ShortAdjudication results
Comments

Must not be specified when 'focal=true' for this insurance.

Control0..1
TypeReference(ClaimResponse)
Is Modifierfalse
Summaryfalse
Requirements

An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
554. Claim.accident
Definition

Details of an accident which resulted in injuries which required the products and services listed in the claim.

ShortDetails of the event
Control0..1
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
556. Claim.accident.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
558. Claim.accident.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
560. Claim.accident.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
562. Claim.accident.date
Definition

Date of an accident event related to the products and services contained in the claim.

ShortWhen the incident occurred
Comments

The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.

Control1..1
Typedate
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Required for audit purposes and adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
564. Claim.accident.type
Definition

The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.

ShortThe nature of the accident
Control0..1
BindingUnless not suitable, these codes SHALL be taken from ActIncidentCode

Type of accident: work place, auto, etc.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Coverage may be dependant on the type of accident.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
566. Claim.accident.location[x]
Definition

The physical location of the accident event.

ShortWhere the event occurred
Control0..1
TypeAddress
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

Required for audit purposes and determination of applicable insurance liability.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
568. Claim.accident.location[x].id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
570. Claim.accident.location[x].extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.accident.location[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
572. Claim.accident.location[x].use
Definition

The purpose of this address.

Shorthome | work | temp | old | billing - purpose of this address
Comments

Applications can assume that an address is current unless it explicitly says that it is temporary or old.

Control0..1
BindingThe codes SHALL be taken from AddressUse

The use of an address.

Typecode
Is Modifiertrue because This is labeled as &quot;Is Modifier&quot; because applications should not mistake a temporary or old address etc.for a current/permanent one
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows an appropriate address to be chosen from a list of many.

Example<br/><b>General</b>:home
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
574. Claim.accident.location[x].type
Definition

Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.

Shortpostal | physical | both
Comments

The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

Control0..1
BindingThe codes SHALL be taken from AddressType

The type of an address (physical / postal).

Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Example<br/><b>General</b>:both
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
576. Claim.accident.location[x].text
Definition

Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.

ShortText representation of the address
Comments

Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

A renderable, unencoded form.

Example<br/><b>General</b>:137 Nowhere Street, Erewhon 9132
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
578. Claim.accident.location[x].line
Definition

This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.

ShortStreet name, number, direction & P.O. Box etc.
Control0..*
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Example<br/><b>General</b>:137 Nowhere Street
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
580. Claim.accident.location[x].city
Definition

The name of the city, town, suburb, village or other community or delivery center.

ShortName of city, town etc.
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Alternate NamesMunicpality
Example<br/><b>General</b>:Erewhon
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
582. Claim.accident.location[x].district
Definition

The name of the administrative area (county).

ShortDistrict name (aka county)
Comments

District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Alternate NamesCounty
Example<br/><b>General</b>:Madison
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
584. Claim.accident.location[x].state
Definition

Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).

ShortSub-unit of country (abbreviations ok)
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Alternate NamesProvince, Territory
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
586. Claim.accident.location[x].postalCode
Definition

A postal code designating a region defined by the postal service.

ShortPostal code for area
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Alternate NamesZip
Example<br/><b>General</b>:9132
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
588. Claim.accident.location[x].country
Definition

Country - a nation as commonly understood or generally accepted.

ShortCountry (e.g. can be ISO 3166 2 or 3 letter code)
Comments

ISO 3166 3 letter codes can be used in place of a human readable country name.

Control0..1
BindingThe codes SHALL be taken from Iso3166-1-2
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
590. Claim.accident.location[x].period
Definition

Time period when address was/is in use.

ShortTime period when address was/is in use
Control0..1
TypePeriod
Is Modifierfalse
Summarytrue
Requirements

Allows addresses to be placed in historical context.

Example<br/><b>General</b>:&lt;valuePeriod&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;start&nbsp;value=&quot;2010-03-23&quot;/&gt;<br/>&nbsp;&nbsp;&lt;end&nbsp;value=&quot;2010-07-01&quot;/&gt;<br/>&lt;/valuePeriod&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
592. Claim.item
Definition

A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

ShortProduct or service provided
Control1..999
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

The items to be processed for adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
594. Claim.item.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
596. Claim.item.extension
Definition

An Extension

ShortExtension
Control1..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Claim.item.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
598. Claim.item.extension:gfeBillingProviderLineItemCtrlNum
Slice NamegfeBillingProviderLineItemCtrlNum
Definition

This extension is used by the provider to assign a unique identifier to this item. The intent of this element is to allow the provider to assign something other than 'line number' for their purposes (e.g. tracking and troubleshooting).

ShortExtension
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(GFEBillingProviderLineItemCtrlNum) (Extension Type: Identifier)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
600. Claim.item.extension:serviceDescription
Slice NameserviceDescription
Definition

This extension is used to communicate a plain language description of the procedure, product, or service.

ShortService Description
Control1..1
This element is affected by the following invariants: ele-1
TypeExtension(Service Description) (Extension Type: string)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
602. Claim.item.extension:ProviderEventMethodology
Slice NameProviderEventMethodology
Definition

This extension is used for indicating the method a provider used to group services, and those providing such services, beyond what may be indicated through DRGs that the payer or patient may find helpful (e.g. grouping services by a standardized episode of care definition). This is provider generated text and should not be modified by the payer.

ShortProvider Event Methodology
Comments

The method a provider used to group services. The extension definition contains additional detail

Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(ProviderEventMethodology) (Extension Type: string)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
604. Claim.item.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
606. Claim.item.sequence
Definition

A number to uniquely identify item entries.

ShortItem instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
608. Claim.item.careTeamSequence
Definition

CareTeam members related to this service or product.

ShortApplicable careTeam members
Control0..*
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Need to identify the individuals and their roles in the provision of the product or service.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
610. Claim.item.diagnosisSequence
Definition

Diagnosis applicable for this service or product.

ShortApplicable diagnoses
Control0..*
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Need to related the product or service to the associated diagnoses.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
612. Claim.item.procedureSequence
Definition

Procedures applicable for this service or product.

ShortApplicable procedures
Control0..*
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Need to provide any listed specific procedures to support the product or service being claimed.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
614. Claim.item.informationSequence
Definition

Exceptions, special conditions and supporting information applicable for this service or product.

ShortApplicable exception and supporting information
Control0..*
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Need to reference the supporting information items that relate directly to this product or service.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
616. Claim.item.revenue
Definition

The type of revenue or cost center providing the product and/or service.

ShortRevenue or cost center code - must provide a value for the Institutional case
Control1..1
BindingThe codes SHALL be taken from PCT GFE NUBC Revenue Value Set
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed in the processing of institutional claims.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
618. Claim.item.category
Definition

Code to identify the general type of benefits under which products and services are provided.

ShortBenefit classification
Comments

Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

Control0..1
BindingFor example codes, see BenefitCategoryCodes

Benefit categories such as: oral-basic, major, glasses.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
620. Claim.item.productOrService
Definition

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

ShortBilling, service, product, or drug code
Comments

Can include null or N/A or data absent reason for the In-Patient Institutional case.

Control1..1
BindingThe codes SHALL be taken from Claim Medical Product or Service Value Set
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Necessary to state what was provided or done.

Alternate NamesDrug Code, Bill Code, Service Code
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
622. Claim.item.modifier
Definition

Item typification or modifiers codes to convey additional context for the product or service.

ShortProduct or service billing modifiers
Comments

For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

Control0..4
BindingThe codes SHALL be taken from PCT GFE Item CPT - HCPCS Value Set
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
624. Claim.item.programCode
Definition

Identifies the program under which this may be recovered.

ShortProgram the product or service is provided under
Comments

For example: Neonatal program, child dental program or drug users recovery program.

Control0..*
BindingFor example codes, see ExampleProgramReasonCodes

Program specific reason codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
626. Claim.item.serviced[x]
Definition

This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication

ShortThis is the planned or estimated date(s)s of service
Control1..1
TypeChoice of: date, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summaryfalse
Requirements

Needed to determine whether the service or product was provided during the term of the insurance coverage.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
628. Claim.item.location[x]
Definition

Where the product or service was provided.

ShortPlace of service or where product was supplied
Control0..1
BindingFor example codes, see ExampleServicePlaceCodes

Place of service: pharmacy, school, prison, etc.

TypeChoice of: CodeableConcept, Address, Reference(Location)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Requirements

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Claim.item.location[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
630. Claim.item.location[x]:locationCodeableConcept
Slice NamelocationCodeableConcept
Definition

Where the product or service was provided.

ShortPlace of service or where product was supplied
Control0..1
BindingThe codes SHALL be taken from PCT GFE CMS Place of Service Value Set
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
632. Claim.item.quantity
Definition

The number of repetitions of a service or product.

ShortCount of products or services
Control1..1
TypeQuantity(SimpleQuantity)
Is Modifierfalse
Summaryfalse
Requirements

Required when the product or service code does not convey the quantity provided.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
634. Claim.item.unitPrice
Definition

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

ShortFee, charge or cost per item
Control0..1
TypeMoney
Is Modifierfalse
Summaryfalse
Requirements

The amount charged to the patient by the provider for a single unit.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
636. Claim.item.factor
Definition

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

ShortPrice scaling factor
Comments

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

Control0..1
Typedecimal
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
638. Claim.item.net
Definition

The quantity times the unit price for an additional service or product or charge.

ShortTotal charge amount for the service line
Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control1..1
TypeMoney
Is Modifierfalse
Summaryfalse
Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
640. Claim.item.udi
Definition

Unique Device Identifiers associated with this line item.

ShortUnique device identifier
Control0..*
TypeReference(Device)
Is Modifierfalse
Summaryfalse
Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
642. Claim.item.bodySite
Definition

Physical service site on the patient (limb, tooth, etc.).

ShortAnatomical location
Comments

For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

Control0..1
BindingFor example codes, see OralSiteCodes

The code for the teeth, quadrant, sextant and arch.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Allows insurer to validate specific procedures.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
644. Claim.item.subSite
Definition

A region or surface of the bodySite, e.g. limb region or tooth surface(s).

ShortAnatomical sub-location
Control0..*
BindingFor example codes, see SurfaceCodes

The code for the tooth surface and surface combinations.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Allows insurer to validate specific procedures.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
646. Claim.item.encounter
Definition

The Encounters during which this Claim was created or to which the creation of this record is tightly associated.

ShortEncounters related to this billed item
Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

Control0..*
TypeReference(Encounter)
Is Modifierfalse
Summaryfalse
Requirements

Used in some jurisdictions to link clinical events to claim items.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
648. Claim.item.detail
Definition

A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

ShortDrug Identification Information
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

The items to be processed for adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
650. Claim.item.detail.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
652. Claim.item.detail.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
654. Claim.item.detail.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
656. Claim.item.detail.sequence
Definition

A number to uniquely identify item entries.

ShortItem instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
658. Claim.item.detail.revenue
Definition

The type of revenue or cost center providing the product and/or service.

ShortRevenue or cost center code
Control0..1
BindingFor example codes, see ExampleRevenueCenterCodes

Codes for the revenue or cost centers supplying the service and/or products.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed in the processing of institutional claims.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
660. Claim.item.detail.category
Definition

Code to identify the general type of benefits under which products and services are provided.

ShortBenefit classification
Comments

Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

Control0..1
BindingFor example codes, see BenefitCategoryCodes

Benefit categories such as: oral-basic, major, glasses.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
662. Claim.item.detail.productOrService
Definition

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

ShortBilling, service, product, or drug code
Comments

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Control1..1
BindingThe codes SHALL be taken from PCT GFE Item NDC Value Set
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Necessary to state what was provided or done.

Alternate NamesDrug Code, Bill Code, Service Code
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
664. Claim.item.detail.modifier
Definition

Item typification or modifiers codes to convey additional context for the product or service.

ShortService/Product billing modifiers
Comments

For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

Control0..*
BindingFor example codes, see ModifierTypeCodes

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
666. Claim.item.detail.programCode
Definition

Identifies the program under which this may be recovered.

ShortProgram the product or service is provided under
Comments

For example: Neonatal program, child dental program or drug users recovery program.

Control0..*
BindingFor example codes, see ExampleProgramReasonCodes

Program specific reason codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
668. Claim.item.detail.quantity
Definition

The number of repetitions of a service or product.

ShortCount of products or services
Control0..1
TypeQuantity(SimpleQuantity)
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Required when the product or service code does not convey the quantity provided.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
670. Claim.item.detail.unitPrice
Definition

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

ShortFee, charge or cost per item
Control0..1
TypeMoney
Is Modifierfalse
Summaryfalse
Requirements

The amount charged to the patient by the provider for a single unit.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
672. Claim.item.detail.factor
Definition

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

ShortPrice scaling factor
Comments

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

Control0..1
Typedecimal
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
674. Claim.item.detail.net
Definition

The quantity times the unit price for an additional service or product or charge.

ShortTotal item cost
Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control0..1
TypeMoney
Is Modifierfalse
Summaryfalse
Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
676. Claim.item.detail.udi
Definition

Unique Device Identifiers associated with this line item.

ShortUnique device identifier
Control0..*
TypeReference(Device)
Is Modifierfalse
Summaryfalse
Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
678. Claim.item.detail.subDetail
Definition

A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

ShortProduct or service provided
Control0..*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

The items to be processed for adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
680. Claim.item.detail.subDetail.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
682. Claim.item.detail.subDetail.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
684. Claim.item.detail.subDetail.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
686. Claim.item.detail.subDetail.sequence
Definition

A number to uniquely identify item entries.

ShortItem instance identifier
Control1..1
TypepositiveInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
688. Claim.item.detail.subDetail.revenue
Definition

The type of revenue or cost center providing the product and/or service.

ShortRevenue or cost center code
Control0..1
BindingFor example codes, see ExampleRevenueCenterCodes

Codes for the revenue or cost centers supplying the service and/or products.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed in the processing of institutional claims.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
690. Claim.item.detail.subDetail.category
Definition

Code to identify the general type of benefits under which products and services are provided.

ShortBenefit classification
Comments

Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

Control0..1
BindingFor example codes, see BenefitCategoryCodes

Benefit categories such as: oral-basic, major, glasses.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
692. Claim.item.detail.subDetail.productOrService
Definition

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

ShortBilling, service, product, or drug code
Comments

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Control1..1
BindingFor example codes, see USCLSCodes

Allowable service and product codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Necessary to state what was provided or done.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
694. Claim.item.detail.subDetail.modifier
Definition

Item typification or modifiers codes to convey additional context for the product or service.

ShortService/Product billing modifiers
Comments

For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

Control0..*
BindingFor example codes, see ModifierTypeCodes

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
696. Claim.item.detail.subDetail.programCode
Definition

Identifies the program under which this may be recovered.

ShortProgram the product or service is provided under
Comments

For example: Neonatal program, child dental program or drug users recovery program.

Control0..*
BindingFor example codes, see ExampleProgramReasonCodes

Program specific reason codes.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
698. Claim.item.detail.subDetail.quantity
Definition

The number of repetitions of a service or product.

ShortCount of products or services
Control0..1
TypeQuantity(SimpleQuantity)
Is Modifierfalse
Summaryfalse
Requirements

Required when the product or service code does not convey the quantity provided.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
700. Claim.item.detail.subDetail.unitPrice
Definition

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

ShortFee, charge or cost per item
Control0..1
TypeMoney
Is Modifierfalse
Summaryfalse
Requirements

The amount charged to the patient by the provider for a single unit.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
702. Claim.item.detail.subDetail.factor
Definition

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

ShortPrice scaling factor
Comments

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

Control0..1
Typedecimal
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
704. Claim.item.detail.subDetail.net
Definition

The quantity times the unit price for an additional service or product or charge.

ShortTotal item cost
Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control0..1
TypeMoney
Is Modifierfalse
Summaryfalse
Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
706. Claim.item.detail.subDetail.udi
Definition

Unique Device Identifiers associated with this line item.

ShortUnique device identifier
Control0..*
TypeReference(Device)
Is Modifierfalse
Summaryfalse
Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
708. Claim.total
Definition

The total value of the all the items in the claim.

ShortTotal GFE Charges Submitted
Control1..1
TypeMoney
Is Modifierfalse
Summaryfalse
Requirements

Used for control total purposes.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))