Left: | PCT Good Faith Estimate Professional (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional) |
Right: | PCT Good Faith Estimate Professional (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional) |
Error | StructureDefinition.version | Values for version differ: '0.1.0' vs '1.0.0' |
Information | StructureDefinition.date | Values for date differ: '2021-12-04T21:54:35+00:00' vs '2023-03-30T13:34:22+00:00' |
Information | Claim.extension | Element minimum cardinalities differ: '2' vs '1' |
Information | Claim.identifier | Element minimum cardinalities differ: '0' vs '1' |
Warning | Claim.patient | Elements differ in definition for mustSupport: 'true' vs 'false' |
Warning | Claim.provider.extension | Elements differ in short: 'Additional content defined by implementations' vs 'Extension' |
Warning | Claim.provider.extension | Elements differ in 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.' vs 'An Extension' |
Information | Claim.provider.extension | Element minimum cardinalities differ: '0' vs '1' |
Warning | Claim.priority | Elements differ in definition for mustSupport: 'true' vs 'false' |
Warning | Claim.facility | Elements differ in definition for mustSupport: 'true' vs 'false' |
Warning | Claim.careTeam.provider | Elements differ in definition for mustSupport: 'true' vs 'false' |
Warning | Claim.careTeam.role | Elements differ in definition for mustSupport: 'true' vs 'false' |
Warning | Claim.careTeam.qualification | Elements differ in definition for mustSupport: 'true' vs 'false' |
Warning | Claim.procedure.extension | Elements differ in short: 'Additional content defined by implementations' vs 'Extension' |
Warning | Claim.procedure.extension | Elements differ in 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.' vs 'An Extension' |
Information | Claim.procedure.extension | Element minimum cardinalities differ: '0' vs '1' |
Warning | Claim.insurance.coverage | Elements differ in definition for mustSupport: 'true' vs 'false' |
Warning | Claim.insurance.preAuthRef | Elements differ in definition for mustSupport: 'true' vs 'false' |
Warning | Claim.item | Elements differ in definition for mustSupport: 'true' vs 'false' |
Information | Claim.item.extension | Element minimum cardinalities differ: '0' vs '1' |
Warning | Claim.item.careTeamSequence | Elements differ in definition for mustSupport: 'false' vs 'true' |
Warning | Claim.item.productOrService | Elements differ in comments: 'Must be provided with an actual CPT/HCPCS value. Can’t be null or N/A or data absent reason.' vs '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'.' |
Warning | Claim.item.serviced[x] | Elements differ in short: 'Date or dates of service or product delivery' vs 'This is the planned or estimated date(s)s of service' |
Warning | Claim.item.serviced[x] | Elements differ in definition: 'The date or dates when the service or product was supplied, performed or completed.' vs 'This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication' |
Warning | Claim.item.serviced[x] | Elements differ in definition for mustSupport: 'false' vs 'true' |
Information | Claim.item.serviced[x] | Element minimum cardinalities differ: '0' vs '1' |
Warning | Claim.item.quantity | Elements differ in definition for mustSupport: 'true' vs 'false' |
Information | Claim.item.unitPrice | Element minimum cardinalities differ: '0' vs '1' |
Warning | Claim.item.net | Elements differ in short: 'Total item cost' vs 'Total charge amount for the service line' |
Warning | Claim.item.net | Elements differ in definition for mustSupport: 'true' vs 'false' |
Warning | Claim.item.detail.extension | Elements differ in short: 'Extension' vs 'Additional content defined by implementations' |
Warning | Claim.item.detail.extension | Elements differ in definition: 'An Extension' vs '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.' |
Name | Value | Comments | |
---|---|---|---|
abstract | false | ||
baseDefinition | http://hl7.org/fhir/StructureDefinition/Claim | ||
copyright | |||
date | 2021-12-04T21:54:35+00:00 | 2023-03-30T13:34:22+00:00 |
|
description | PCT Good Faith Estimate Professional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for a professional GFE submission. | ||
experimental | |||
fhirVersion | 4.0.1 | ||
jurisdiction | |||
jurisdiction[0] | urn:iso:std:iso:3166#US | ||
kind | resource | ||
name | PCTGFEProfessional | ||
publisher | HL7 International - Financial Management Work Group | ||
purpose | |||
status | active | ||
title | PCT Good Faith Estimate Professional | ||
type | Claim | ||
url | http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional | ||
version | 0.1.0 | 1.0.0 |
|
Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | L Type | L Description & Constraints | Comments | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||||||||
id | Σ | 0..1 | string | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |||||||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
Slices for extension | 2..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| ||||||||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
identifier | 0..* | Identifier | Business Identifier for claim | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by pattern:type |
| ||||||||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"professional","display":"Professional"}]} | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"professional"}]} | |||||||||
subType | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | |||||||||||
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination | |||||||||
patient | SΣ | 1..1 | Reference(PCT Patient) | The recipient of the products and services | Σ | 1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services |
| ||||||||
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim | Σ | 0..1 | Period | Relevant time frame for the claim | |||||||||
created | Σ | 1..1 | dateTime | Resource creation date | Σ | 1..1 | dateTime | Resource creation date | |||||||||
enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||||||||
insurer | Σ | 1..1 | Reference(PCT Organization) | Target | Σ | 1..1 | Reference(PCT Organization) | Target | |||||||||
provider | Σ | 1..1 | Reference(PCT Organization | PCT PractitionerRole) | Billing provider - party responsible for the GFE | Σ | 1..1 | Reference(PCT Organization | PCT Practitioner) | Billing provider - party responsible for the GFE | |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| ||||||||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | |||||||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | |||||||||
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | |||||||||
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource | |||||||||
priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ?? (required) | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ?? (required) |
| ||||||||
fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
related | 0..* | BackboneElement | Prior or corollary claims | 0..* | BackboneElement | Prior or corollary claims | |||||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
claim | 0..1 | Reference(Claim) | Reference to the related claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||||||||
relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. | |||||||||||
reference | 0..1 | Identifier | File or case reference | 0..1 | Identifier | File or case reference | |||||||||||
prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||||||||
originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||||||||
payee | S | 0..1 | BackboneElement | Recipient of benefits payable | S | 0..1 | BackboneElement | Recipient of benefits payable | |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
type | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. | |||||||||||
party | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |||||||||||
referral | 0..1 | Reference(ServiceRequest) | Treatment referral | 0..1 | Reference(ServiceRequest) | Treatment referral | |||||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | |||||||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | |||||||||
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | |||||||||
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource | |||||||||
facility | S | 0..1 | Reference(PCT Location) | Servicing facility | 0..1 | Reference(Location) | Servicing facility |
| |||||||||
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role | |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
sequence | 1..1 | positiveInt | Order of care team | 1..1 | positiveInt | Order of care team | |||||||||||
provider | S | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization |
| |||||||||
responsible | 0..1 | boolean | Indicator of the lead practitioner | 0..1 | boolean | Indicator of the lead practitioner | |||||||||||
role | S | 1..1 | CodeableConcept | Function within the team Binding: ?? (required) | 1..1 | CodeableConcept | Function within the team Binding: ?? (required) |
| |||||||||
qualification | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (required) | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (required) |
| |||||||||
Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
sequence | 1..1 | positiveInt | Information instance identifier | 1..1 | positiveInt | Information instance identifier | |||||||||||
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) | |||||||||||
code | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | |||||||||||
timing[x] | 0..1 | date, Period | When it occurred | 0..1 | date, Period | When it occurred | |||||||||||
value[x] | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | |||||||||||
reason | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | |||||||||||
Slices for diagnosis | S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type | S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type | |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
sequence | 1..1 | positiveInt | Diagnosis instance identifier | 1..1 | positiveInt | Diagnosis instance identifier | |||||||||||
diagnosis[x] | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. | |||||||||||
type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required) | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required) | |||||||||
onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | |||||||||||
packageCode | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | |||||||||||
Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type | |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| ||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
sequence | 1..1 | positiveInt | Procedure instance identifier | 1..1 | positiveInt | Procedure instance identifier | |||||||||||
type | S | 0..* | CodeableConcept | Category of Procedure Binding: ?? (required) | S | 0..* | CodeableConcept | Category of Procedure Binding: ?? (required) | |||||||||
date | 0..1 | dateTime | When the procedure was performed | 0..1 | dateTime | When the procedure was performed | |||||||||||
procedure[x] | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. | |||||||||||
udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
insurance | Σ | 1..* | BackboneElement | Patient insurance information | Σ | 1..* | BackboneElement | Patient insurance information | |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier | Σ | 1..1 | positiveInt | Insurance instance identifier | |||||||||
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication | Σ | 1..1 | boolean | Coverage to be used for adjudication | |||||||||
identifier | 0..1 | Identifier | Pre-assigned Claim number | 0..1 | Identifier | Pre-assigned Claim number | |||||||||||
coverage | SΣ | 1..1 | Reference(PCT Coverage) | Insurance information | Σ | 1..1 | Reference(PCT Coverage) | Insurance information |
| ||||||||
businessArrangement | 0..1 | string | Additional provider contract number | 0..1 | string | Additional provider contract number | |||||||||||
preAuthRef | S | 0..2 | string | Prior authorization reference number | 0..2 | string | Prior authorization reference number |
| |||||||||
claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||||||||
accident | 0..1 | BackboneElement | Details of the event | 0..1 | BackboneElement | Details of the event | |||||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
date | 1..1 | date | When the incident occurred | 1..1 | date | When the incident occurred | |||||||||||
type | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | |||||||||||
location[x] | 0..1 | Address, Reference(Location) | Where the event occurred | 0..1 | Address | Where the event occurred | |||||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: ?? (required): The use of an address. Example General: home | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: ?? (required): The use of an address. Example General: home | |||||||||
type | Σ | 0..1 | code | postal | physical | both Binding: ?? (required): The type of an address (physical / postal). Example General: both | Σ | 0..1 | code | postal | physical | both Binding: ?? (required): The type of an address (physical / postal). Example General: both | |||||||||
text | Σ | 0..1 | string | Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132 | Σ | 0..1 | string | Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132 | |||||||||
line | Σ | 0..* | string | Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street | Σ | 0..* | string | Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street | |||||||||
city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon | |||||||||
district | Σ | 0..1 | string | District name (aka county) Example General: Madison | Σ | 0..1 | string | District name (aka county) Example General: Madison | |||||||||
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok) | Σ | 0..1 | string | Sub-unit of country (abbreviations ok) | |||||||||
postalCode | Σ | 0..1 | string | Postal code for area Example General: 9132 | Σ | 0..1 | string | Postal code for area Example General: 9132 | |||||||||
country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: ?? (required) | |||||||||
period | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"} | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"} | |||||||||
item | S | 1..50 | BackboneElement | Product or service provided | 1..50 | BackboneElement | Product or service provided |
| |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| ||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
careTeamSequence | 0..* | positiveInt | Applicable careTeam members | S | 0..* | positiveInt | Applicable careTeam members |
| |||||||||
diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | 0..* | positiveInt | Applicable diagnoses | |||||||||||
procedureSequence | 0..* | positiveInt | Applicable procedures | 0..* | positiveInt | Applicable procedures | |||||||||||
informationSequence | 0..* | positiveInt | Applicable exception and supporting information | 0..* | positiveInt | Applicable exception and supporting information | |||||||||||
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) |
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modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: ?? (required) | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: ?? (required) | |||||||||
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
serviced[x] | 0..1 | date, Period | Date or dates of service or product delivery | S | 1..1 | date, Period | This is the planned or estimated date(s)s of service |
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Slices for location[x] | 1..1 | CodeableConcept | Place of service or where product was supplied Slice: Unordered, Closed by type:$this Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | 1..1 | CodeableConcept | Place of service or where product was supplied Slice: Unordered, Closed by type:$this Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | |||||||||||
quantity | S | 1..1 | ?? | Count of products or services | 1..1 | ?? | Count of products or services |
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unitPrice | 0..1 | Money | Fee, charge or cost per item | 1..1 | Money | Fee, charge or cost per item |
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factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
net | S | 1..1 | Money | Total item cost | 1..1 | Money | Total charge amount for the service line |
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udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
bodySite | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |||||||||||
subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |||||||||||
encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||||||||
detail | S | 0..* | BackboneElement | Drug Identification Information | S | 0..* | BackboneElement | Drug Identification Information | |||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations |
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modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | |||||||||||
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
quantity | S | 0..1 | ?? | Count of products or services | S | 0..1 | ?? | Count of products or services | |||||||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
subDetail | 0..* | BackboneElement | Product or service provided | 0..* | BackboneElement | Product or service provided | |||||||||||
id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
total | 1..1 | Money | Total GFE Charges Submitted | 1..1 | Money | Total GFE Charges Submitted | |||||||||||
Documentation for this format |