Patient Cost Transparency Implementation Guide
2.0.0 - STU 2 United States of America flag

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v2.0.0: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: PCT Good Faith Estimate Institutional

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-institutional Version: 2.0.0
Standards status: Trial-use Maturity Level: 2 Computable Name: PCTGFEInstitutional
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.12

PCT Good Faith Estimate Institutional is a profile for an institutional provider to capture estimation for items and services for the patient or, optionally, to submit to a payer (for patients using insurance). If submitting to a payer, this includes the data needed for a payer to process and create an Advanced EOB. This profile is used for an institutional GFE submission.

Notes on Fields

  • The estimated service date, when available at the header level, is placed in Claim.billablePeriod. If the estimated date of service is available at the line level is placed in Claim.item.serviced[x].
  • diagnosis:principal - If Diagnosis code(s) is known, it is important that it be shared in the GFE through the Claim.diagnosis:principal or additional diagnosis data elements particularly when the GFE is being sent to a payer for an insured patient. Payers very often need the diagnosis to be able to provide an estimate. Without the diagnosis, payers may assume the service is diagnostic and thus the patient responsibility may be higher or not covered at all than the diagnosis, such as for preventative services, would otherwise indicate. It is understood that in certain situations, such as scheduled services or GFE requests prior to orders, diagnosis is not needed or may not yet be known. However, when it is known, it is important that this information be shared to ensure the best possible estimate is provided to the patient.

Examples of .providerEventMethodology usage examples below:

Example 1 – A provider is offering both a surgical and a drug therapy-based option to the patient. The provider can add text such as "Surgical care option" and "Drug therapy option" to the Good Faith Estimate (GFE) so that the patient could easily understand the options without having to understand different CPT codes.
    Example 2 – A provider added services to a previously submitted GFE. They would be able to add "Added physical therapist on Sep 18, ignore estimates submitted on Sep 17".

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 1.1.0:

  • The resource metadata has changed (description)
  • The data elements list has changed
  • One or more text definitions, invariants or bindings have changed

    • Formal Views of Profile Content

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

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeServiceLinkingInfo S 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    .... extension:providerEventMethodology S 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... extension:gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    .... identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    ..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    ..... type Σ 1..1 CodeableConcept Description of identifier
    Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: PLAC
    ....... display 1..1 string Representation defined by the system
    Fixed Value: Placer Identifier
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... system SΣ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value Σ 1..1 string The value that is unique
    Example General: 123456
    ... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    ... type Σ 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
    Required Pattern: At least the following
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
    ..... version 0..1 string Version of the system - if relevant
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: institutional
    ..... display 0..1 string Representation defined by the system
    ..... userSelected 0..1 boolean If this coding was chosen directly by the user
    .... text 0..1 string Plain text representation of the concept
    ... use Σ 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
    Required Pattern: predetermination
    ... patient Σ 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... billablePeriod SΣ 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
    ... created Σ 1..1 dateTime Resource creation date
    ... insurer Σ 0..1 Reference(PCT Organization) Target
    ... provider Σ 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:providerTaxonomy 1..1 CodeableConcept Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
    Binding: US Core Provider Role (NUCC) (extensible)
    ..... extension:consentForBalanceBilling S 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    ... priority Σ 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    ... payee S 0..1 BackboneElement Recipient of benefits payable
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... type 1..1 CodeableConcept Category of recipient
    Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    .... party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    ... Slices for careTeam S 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role
    .... careTeam:All Slices Content/Rules for all slices
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:attending S 0..1 BackboneElement Members of the care team
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: attending
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 1..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:operating S 0..2 BackboneElement Members of the care team
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: operating
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... careTeam:rendering S 0..1 BackboneElement Members of the care team
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: rendering
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... careTeam:referring S 0..1 BackboneElement Members of the care team
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: referring
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ... Slices for supportingInfo S 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category
    .... supportingInfo:All Slices Content/Rules for all slices
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    .... supportingInfo:typeOfBill S 1..1 BackboneElement Supporting information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: typeofbill
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    .... supportingInfo:serviceFacility S 0..1 BackboneElement Service Facility
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: servicefacility
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Closed by type:$this
    ...... value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    .... supportingInfo:drg S 0..1 BackboneElement Supporting information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: drg
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    .... supportingInfo:pointoforigin S 0..1 BackboneElement Supporting information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: pointoforigin
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    .... supportingInfo:admtype S 0..1 BackboneElement Supporting information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admtype
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    ... Slices for diagnosis S 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type
    .... diagnosis:All Slices Content/Rules for all slices
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 Nature of illness or problem
    Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
    ...... diagnosisCodeableConcept CodeableConcept
    ...... diagnosisReference Reference(Condition)
    ..... type S 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    .... diagnosis:principal S 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admitting
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: patientreasonforvisit
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: externalcauseofinjury
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: secondary
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ... Slices for procedure S 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type
    .... procedure:All Slices Content/Rules for all slices
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    ..... type S 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    ..... procedure[x] 1..1 Specific clinical procedure
    Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
    ...... procedureCodeableConcept CodeableConcept
    ...... procedureReference Reference(Procedure)
    .... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1
    ..... type S 1..1 CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    .... procedure:other S 0..24 BackboneElement Clinical procedures performed
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    ..... type S 1..1 CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: other
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    ... insurance Σ 1..* BackboneElement Patient insurance information
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence Σ 1..1 positiveInt Insurance instance identifier
    .... focal Σ 1..1 boolean Coverage to be used for adjudication
    .... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
    ..... Slices for extension Content/Rules for all slices
    ...... extension:dataAbsentReason S 0..1 code Coverage may be not applicable if estimate is for self-pay or uninsured
    URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
    Binding: DataAbsentReason (required)
    .... preAuthRef 0..1 string Prior authorization reference number
    ... item 1..999 BackboneElement Product or service provided
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:gfeBillingProviderLineItemCtrlNum S 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    ..... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... extension:ProviderEventMethodology S 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence 1..1 positiveInt Item instance identifier
    .... revenue 1..1 CodeableConcept Revenue or cost center code - must provide a value for the Institutional case
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... serviced[x] S 1..1 This is the planned or estimated date(s)s of service
    ..... servicedDate date
    ..... servicedPeriod Period
    .... Slices for location[x] 0..1 Place of service or where product was supplied
    Slice: Unordered, Open by type:$this
    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
    ..... locationCodeableConcept CodeableConcept
    ..... locationAddress Address
    ..... locationReference Reference(Location)
    ..... location[x]:locationCodeableConcept S 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    .... quantity 1..1 SimpleQuantity(4.0.1) Count of products or services
    .... net 1..1 Money Total charge amount for the service line
    .... detail S 0..* BackboneElement Drug Identification Information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Item instance identifier
    ..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    ..... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    ... total 1..1 Money Total GFE Charges Submitted

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Claim.identifier:PLAC.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
    Claim.identifier:PLAC.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
    Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
    Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
    Claim.use Base required Use 📍4.0.1 FHIR Std.
    Claim.priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
    Claim.careTeam.role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:attending.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:attending.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:operating.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:rendering.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:referring.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.0 This IG
    Claim.supportingInfo:serviceFacility.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:drg.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.0 This IG
    Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis.type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:principal.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:admitting.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:patientReasonForVisit.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:externalcauseofinjury.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:other.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.0 This IG
    Claim.procedure:other.​type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.0 This IG
    Claim.item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
    Claim.item.location[x]:locationCodeableConcept Base required PCT GFE CMS Place of Service Value Set 📦2.0.0 This IG
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
    dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
    dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
    ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
    ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
    pct-cpt-display error Claim.item.productOrService.coding, Claim.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    This structure is derived from Claim

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Claim Claim
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeServiceLinkingInfo S 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    .... extension:providerEventMethodology S 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... extension:gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
    ... Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    .... identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    ..... type 1..1 CodeableConcept Description of identifier
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: PLAC
    ....... display 1..1 string Representation defined by the system
    Fixed Value: Placer Identifier
    ..... system S 0..1 uri The namespace for the identifier value
    ..... value 1..1 string The value that is unique
    ... type 1..1 CodeableConcept Category or discipline
    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: institutional
    ... use 1..1 code claim | preauthorization | predetermination
    Required Pattern: predetermination
    ... patient 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... billablePeriod S 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
    ... insurer 0..1 Reference(PCT Organization) Target
    ... provider 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    .... extension 1..* Extension Extension
    .... Slices for extension Content/Rules for all slices
    ..... extension:providerTaxonomy 1..1 CodeableConcept Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
    Binding: US Core Provider Role (NUCC) (extensible)
    ..... extension:consentForBalanceBilling S 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    ... priority 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    ... payee S 0..1 BackboneElement Recipient of benefits payable
    .... party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    ... referral
    .... extension 1..* Extension Extension
    .... Slices for extension Content/Rules for all slices
    ..... extension:referralNumber 1..1 string Referral Number
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
    ... Slices for careTeam S 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role
    .... careTeam:All Slices Content/Rules for all slices
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:attending S 0..1 BackboneElement Members of the care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: attending
    ..... qualification 1..1 CodeableConcept Practitioner credential or specialization
    .... careTeam:operating S 0..2 BackboneElement Members of the care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: operating
    .... careTeam:rendering S 0..1 BackboneElement Members of the care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: rendering
    .... careTeam:referring S 0..1 BackboneElement Members of the care team
    ..... role 1..1 CodeableConcept Function within the team
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: referring
    ... Slices for supportingInfo S 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category
    .... supportingInfo:All Slices Content/Rules for all slices
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    .... supportingInfo:typeOfBill S 1..1 BackboneElement Supporting information
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: typeofbill
    ..... code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    .... supportingInfo:serviceFacility S 0..1 BackboneElement Service Facility
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: servicefacility
    ..... Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Open by type:$this
    ...... value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    .... supportingInfo:drg S 0..1 BackboneElement Supporting information
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: drg
    ..... code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    .... supportingInfo:pointoforigin S 0..1 BackboneElement Supporting information
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: pointoforigin
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    .... supportingInfo:admtype S 0..1 BackboneElement Supporting information
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admtype
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    ... Slices for diagnosis S 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type
    .... diagnosis:All Slices Content/Rules for all slices
    ..... type S 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    .... diagnosis:principal S 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    .... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admitting
    .... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: patientreasonforvisit
    .... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: externalcauseofinjury
    .... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
    ..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: secondary
    ... Slices for procedure S 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type
    .... procedure:All Slices Content/Rules for all slices
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... type S 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    .... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
    ..... Slices for extension Content/Rules for all slices
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1
    ..... type 1..1 CodeableConcept Category of Procedure
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    .... procedure:other S 0..24 BackboneElement Clinical procedures performed
    ..... Slices for extension Content/Rules for all slices
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... type 1..1 CodeableConcept Category of Procedure
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: other
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    ... insurance
    .... coverage 1..1 Reference(PCT Coverage) Insurance information
    ..... Slices for extension Content/Rules for all slices
    ...... extension:dataAbsentReason S 0..1 code Coverage may be not applicable if estimate is for self-pay or uninsured
    URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
    Binding: DataAbsentReason (required)
    .... preAuthRef 0..1 string Prior authorization reference number
    ... accident
    .... location[x] 0..1 Address Where the event occurred
    ..... country 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
    Binding: Iso3166-1-2 (required)
    ... item 1..999 BackboneElement Product or service provided
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:gfeBillingProviderLineItemCtrlNum S 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    ..... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... extension:ProviderEventMethodology S 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... revenue 1..1 CodeableConcept Revenue or cost center code - must provide a value for the Institutional case
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... serviced[x] S 1..1 date, Period This is the planned or estimated date(s)s of service
    .... Slices for location[x] 0..1 CodeableConcept, Address, Reference(Location) Place of service or where product was supplied
    Slice: Unordered, Open by type:$this
    ..... location[x]:locationCodeableConcept S 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    .... quantity 1..1 SimpleQuantity(4.0.1) Count of products or services
    .... net 1..1 Money Total charge amount for the service line
    .... detail S 0..* BackboneElement Drug Identification Information
    ..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    ..... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    ... total 1..1 Money Total GFE Charges Submitted

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Claim.priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    Claim.careTeam.role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.0 This IG
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.0 This IG
    Claim.diagnosis.type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.0 This IG
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.0 This IG
    Claim.accident.location[x].​country Base required Iso 3166 Part 1: 2 Letter Codes 📦4.0.1 FHIR Std.
    Claim.item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    Claim.item.location[x]:locationCodeableConcept Base required PCT GFE CMS Place of Service Value Set 📦2.0.0 This IG
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    pct-cpt-display error Claim.item.productOrService.coding, Claim.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.
    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    This profile does not constrain the narrative in regard to content, language, or traceability to data elements
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeServiceLinkingInfo S 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    .... extension:providerEventMethodology S 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... extension:gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    .... identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    ..... type Σ 1..1 CodeableConcept Description of identifier
    Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: PLAC
    ....... display 1..1 string Representation defined by the system
    Fixed Value: Placer Identifier
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... system SΣ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value Σ 1..1 string The value that is unique
    Example General: 123456
    ..... period Σ 0..1 Period Time period when id is/was valid for use
    ..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
    ... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    ... type Σ 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
    Required Pattern: At least the following
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
    ..... version 0..1 string Version of the system - if relevant
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: institutional
    ..... display 0..1 string Representation defined by the system
    ..... userSelected 0..1 boolean If this coding was chosen directly by the user
    .... text 0..1 string Plain text representation of the concept
    ... subType 0..1 CodeableConcept More granular claim type
    Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
    ... use Σ 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
    Required Pattern: predetermination
    ... patient Σ 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... billablePeriod SΣ 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
    ... created Σ 1..1 dateTime Resource creation date
    ... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
    ... insurer Σ 0..1 Reference(PCT Organization) Target
    ... provider Σ 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:providerTaxonomy 1..1 CodeableConcept Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
    Binding: US Core Provider Role (NUCC) (extensible)
    ..... extension:consentForBalanceBilling S 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    .... reference 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: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... priority Σ 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    ... fundsReserve 0..1 CodeableConcept For whom to reserve funds
    Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
    ... related 0..* BackboneElement Prior or corollary claims
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... claim 0..1 Reference(Claim) Reference to the related claim
    .... relationship 0..1 CodeableConcept How the reference claim is related
    Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
    .... reference 0..1 Identifier File or case reference
    ... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
    ... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
    ... payee S 0..1 BackboneElement Recipient of benefits payable
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... type 1..1 CodeableConcept Category of recipient
    Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    .... party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    ... referral 0..1 Reference(ServiceRequest) Treatment referral
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:referralNumber 1..1 string Referral Number
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
    .... reference 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: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... facility 0..1 Reference(Location) Servicing facility
    ... Slices for careTeam S 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role
    .... careTeam:All Slices Content/Rules for all slices
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:attending S 0..1 BackboneElement Members of the care team
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: attending
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 1..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:operating S 0..2 BackboneElement Members of the care team
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: operating
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:rendering S 0..1 BackboneElement Members of the care team
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: rendering
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:referring S 0..1 BackboneElement Members of the care team
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: referring
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    ... Slices for supportingInfo S 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category
    .... supportingInfo:All Slices Content/Rules for all slices
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    ..... code 0..1 CodeableConcept Type of information
    Binding: ExceptionCodes (example): The valuset used for additional information codes.
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:typeOfBill S 1..1 BackboneElement Supporting information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: typeofbill
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:serviceFacility S 0..1 BackboneElement Service Facility
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: servicefacility
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: ExceptionCodes (example): The valuset used for additional information codes.
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Closed by type:$this
    ...... value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:drg S 0..1 BackboneElement Supporting information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: drg
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:pointoforigin S 0..1 BackboneElement Supporting information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: pointoforigin
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:admtype S 0..1 BackboneElement Supporting information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admtype
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    ... Slices for diagnosis S 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type
    .... diagnosis:All Slices Content/Rules for all slices
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 Nature of illness or problem
    Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
    ...... diagnosisCodeableConcept CodeableConcept
    ...... diagnosisReference Reference(Condition)
    ..... type S 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:principal S 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admitting
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: patientreasonforvisit
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: externalcauseofinjury
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: secondary
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    ... Slices for procedure S 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type
    .... procedure:All Slices Content/Rules for all slices
    ..... id 0..1 string Unique id for inter-element referencing
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    ..... type S 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    ..... date 0..1 dateTime When the procedure was performed
    ..... procedure[x] 1..1 Specific clinical procedure
    Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
    ...... procedureCodeableConcept CodeableConcept
    ...... procedureReference Reference(Procedure)
    ..... udi 0..* Reference(Device) Unique device identifier
    .... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
    ..... id 0..1 string Unique id for inter-element referencing
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1
    ..... type S 1..1 CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... date 0..1 dateTime When the procedure was performed
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    ..... udi 0..* Reference(Device) Unique device identifier
    .... procedure:other S 0..24 BackboneElement Clinical procedures performed
    ..... id 0..1 string Unique id for inter-element referencing
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    ..... type S 1..1 CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: other
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... date 0..1 dateTime When the procedure was performed
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    ..... udi 0..* Reference(Device) Unique device identifier
    ... insurance Σ 1..* BackboneElement Patient insurance information
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence Σ 1..1 positiveInt Insurance instance identifier
    .... focal Σ 1..1 boolean Coverage to be used for adjudication
    .... identifier 0..1 Identifier Pre-assigned Claim number
    .... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
    ..... id 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
    ...... extension:dataAbsentReason S 0..1 code Coverage may be not applicable if estimate is for self-pay or uninsured
    URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
    Binding: DataAbsentReason (required)
    ..... reference 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: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    ..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    ..... display Σ 0..1 string Text alternative for the resource
    .... businessArrangement 0..1 string Additional provider contract number
    .... preAuthRef 0..1 string Prior authorization reference number
    .... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
    ... accident 0..1 BackboneElement Details of the event
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... date 1..1 date When the incident occurred
    .... type 0..1 CodeableConcept The nature of the accident
    Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
    .... location[x] 0..1 Address Where the event occurred
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 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: AddressUse (required): The use of an address.
    Example General: home
    ..... type Σ 0..1 code postal | physical | both
    Binding: AddressType (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
    ..... 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
    ..... city Σ 0..1 string Name of city, town etc.
    Example General: Erewhon
    ..... district Σ 0..1 string District name (aka county)
    Example General: Madison
    ..... state Σ 0..1 string Sub-unit of country (abbreviations ok)
    ..... postalCode 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)
    Binding: Iso3166-1-2 (required)
    ..... period Σ 0..1 Period Time period when address was/is in use
    Example General: {"start":"2010-03-23","end":"2010-07-01"}
    ... item 1..999 BackboneElement Product or service provided
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:gfeBillingProviderLineItemCtrlNum S 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    ..... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... extension:ProviderEventMethodology S 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence 1..1 positiveInt Item instance identifier
    .... careTeamSequence 0..* positiveInt Applicable careTeam members
    .... diagnosisSequence 0..* positiveInt Applicable diagnoses
    .... procedureSequence 0..* positiveInt Applicable procedures
    .... informationSequence 0..* positiveInt Applicable exception and supporting information
    .... revenue 1..1 CodeableConcept Revenue or cost center code - must provide a value for the Institutional case
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    ..... text Σ 0..1 string Plain text representation of the concept
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    ..... text Σ 0..1 string Plain text representation of the concept
    .... programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    .... serviced[x] S 1..1 This is the planned or estimated date(s)s of service
    ..... servicedDate date
    ..... servicedPeriod Period
    .... Slices for location[x] 0..1 Place of service or where product was supplied
    Slice: Unordered, Open by type:$this
    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
    ..... locationCodeableConcept CodeableConcept
    ..... locationAddress Address
    ..... locationReference Reference(Location)
    ..... location[x]:locationCodeableConcept S 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    .... quantity 1..1 SimpleQuantity(4.0.1) Count of products or services
    .... unitPrice 0..1 Money Fee, charge or cost per item
    .... factor 0..1 decimal Price scaling factor
    .... net 1..1 Money Total charge amount for the service line
    .... udi 0..* Reference(Device) Unique device identifier
    .... bodySite 0..1 CodeableConcept Anatomical location
    Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
    .... subSite 0..* CodeableConcept Anatomical sub-location
    Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
    .... encounter 0..* Reference(Encounter) Encounters related to this billed item
    .... detail S 0..* BackboneElement Drug Identification Information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Item instance identifier
    ..... revenue 0..1 CodeableConcept Revenue or cost center code
    Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
    ..... category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    ..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    ..... modifier 0..* CodeableConcept Service/Product billing modifiers
    Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
    ..... programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    ..... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    ..... unitPrice 0..1 Money Fee, charge or cost per item
    ..... factor 0..1 decimal Price scaling factor
    ..... net 0..1 Money Total item cost
    ..... udi 0..* Reference(Device) Unique device identifier
    ..... subDetail 0..* BackboneElement Product or service provided
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... sequence 1..1 positiveInt Item instance identifier
    ...... revenue 0..1 CodeableConcept Revenue or cost center code
    Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
    ...... category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    ...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: USCLSCodes (example): Allowable service and product codes.
    ...... modifier 0..* CodeableConcept Service/Product billing modifiers
    Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
    ...... programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    ...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
    ...... unitPrice 0..1 Money Fee, charge or cost per item
    ...... factor 0..1 decimal Price scaling factor
    ...... net 0..1 Money Total item cost
    ...... udi 0..* Reference(Device) Unique device identifier
    ... total 1..1 Money Total GFE Charges Submitted

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
    Claim.identifier:PLAC.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
    Claim.identifier:PLAC.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
    Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
    Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
    Claim.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
    Claim.use Base required Use 📍4.0.1 FHIR Std.
    Claim.provider.type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Claim.priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    Claim.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
    Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
    Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
    Claim.referral.type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Claim.careTeam.role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:attending.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:attending.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:operating.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:operating.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:rendering.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:rendering.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:referring.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:referring.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo.​code Base example Exception Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:typeOfBill.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:serviceFacility.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:serviceFacility.​code Base example Exception Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:serviceFacility.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:drg.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.0 This IG
    Claim.supportingInfo:drg.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:pointoforigin.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:admtype.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis.type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:principal.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:principal.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:principal.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:admitting.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:admitting.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:admitting.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:patientReasonForVisit.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:patientReasonForVisit.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:patientReasonForVisit.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:externalcauseofinjury.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:externalcauseofinjury.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:externalcauseofinjury.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:other.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:other.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:other.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.0 This IG
    Claim.procedure:other.​type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.0 This IG
    Claim.insurance.coverage.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Claim.accident.type Base extensible ActIncidentCode 📍3.0.0 THO v6.5
    Claim.accident.location[x].​use Base required AddressUse 📍4.0.1 FHIR Std.
    Claim.accident.location[x].​type Base required AddressType 📍4.0.1 FHIR Std.
    Claim.accident.location[x].​country Base required Iso 3166 Part 1: 2 Letter Codes 📦4.0.1 FHIR Std.
    Claim.item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
    Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
    Claim.item.location[x]:locationCodeableConcept Base required PCT GFE CMS Place of Service Value Set 📦2.0.0 This IG
    Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
    Claim.item.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.0 This IG
    Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
    dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
    dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
    ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
    ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
    pct-cpt-display error Claim.item.productOrService.coding, Claim.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    This structure is derived from Claim

    Summary

    Mandatory: 17 elements(17 nested mandatory elements)
    Must-Support: 38 elements

    Structures

    This structure refers to these other structures:

    Extensions

    This structure refers to these extensions:

    Slices

    This structure defines the following Slices:

    • The element 1 is sliced based on the value of Claim.identifier
    • The element 1 is sliced based on the value of Claim.careTeam
    • The element 1 is sliced based on the value of Claim.supportingInfo
    • The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
    • The element 1 is sliced based on the value of Claim.diagnosis
    • The element 1 is sliced based on the value of Claim.procedure
    • The element 1 is sliced based on the value of Claim.item.location[x]

    Maturity: 2

    Key Elements View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeServiceLinkingInfo S 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    .... extension:providerEventMethodology S 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... extension:gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    .... identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    ..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    ..... type Σ 1..1 CodeableConcept Description of identifier
    Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: PLAC
    ....... display 1..1 string Representation defined by the system
    Fixed Value: Placer Identifier
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... system SΣ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value Σ 1..1 string The value that is unique
    Example General: 123456
    ... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    ... type Σ 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
    Required Pattern: At least the following
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
    ..... version 0..1 string Version of the system - if relevant
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: institutional
    ..... display 0..1 string Representation defined by the system
    ..... userSelected 0..1 boolean If this coding was chosen directly by the user
    .... text 0..1 string Plain text representation of the concept
    ... use Σ 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
    Required Pattern: predetermination
    ... patient Σ 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... billablePeriod SΣ 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
    ... created Σ 1..1 dateTime Resource creation date
    ... insurer Σ 0..1 Reference(PCT Organization) Target
    ... provider Σ 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:providerTaxonomy 1..1 CodeableConcept Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
    Binding: US Core Provider Role (NUCC) (extensible)
    ..... extension:consentForBalanceBilling S 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    ... priority Σ 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    ... payee S 0..1 BackboneElement Recipient of benefits payable
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... type 1..1 CodeableConcept Category of recipient
    Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    .... party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    ... Slices for careTeam S 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role
    .... careTeam:All Slices Content/Rules for all slices
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:attending S 0..1 BackboneElement Members of the care team
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: attending
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 1..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:operating S 0..2 BackboneElement Members of the care team
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: operating
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... careTeam:rendering S 0..1 BackboneElement Members of the care team
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: rendering
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... careTeam:referring S 0..1 BackboneElement Members of the care team
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: referring
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ... Slices for supportingInfo S 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category
    .... supportingInfo:All Slices Content/Rules for all slices
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    .... supportingInfo:typeOfBill S 1..1 BackboneElement Supporting information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: typeofbill
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    .... supportingInfo:serviceFacility S 0..1 BackboneElement Service Facility
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: servicefacility
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Closed by type:$this
    ...... value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    .... supportingInfo:drg S 0..1 BackboneElement Supporting information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: drg
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    .... supportingInfo:pointoforigin S 0..1 BackboneElement Supporting information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: pointoforigin
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    .... supportingInfo:admtype S 0..1 BackboneElement Supporting information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admtype
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    ... Slices for diagnosis S 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type
    .... diagnosis:All Slices Content/Rules for all slices
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 Nature of illness or problem
    Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
    ...... diagnosisCodeableConcept CodeableConcept
    ...... diagnosisReference Reference(Condition)
    ..... type S 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    .... diagnosis:principal S 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admitting
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: patientreasonforvisit
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: externalcauseofinjury
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    .... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: secondary
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ... Slices for procedure S 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type
    .... procedure:All Slices Content/Rules for all slices
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    ..... type S 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    ..... procedure[x] 1..1 Specific clinical procedure
    Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
    ...... procedureCodeableConcept CodeableConcept
    ...... procedureReference Reference(Procedure)
    .... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1
    ..... type S 1..1 CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    .... procedure:other S 0..24 BackboneElement Clinical procedures performed
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    ..... type S 1..1 CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: other
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    ... insurance Σ 1..* BackboneElement Patient insurance information
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence Σ 1..1 positiveInt Insurance instance identifier
    .... focal Σ 1..1 boolean Coverage to be used for adjudication
    .... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
    ..... Slices for extension Content/Rules for all slices
    ...... extension:dataAbsentReason S 0..1 code Coverage may be not applicable if estimate is for self-pay or uninsured
    URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
    Binding: DataAbsentReason (required)
    .... preAuthRef 0..1 string Prior authorization reference number
    ... item 1..999 BackboneElement Product or service provided
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:gfeBillingProviderLineItemCtrlNum S 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    ..... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... extension:ProviderEventMethodology S 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence 1..1 positiveInt Item instance identifier
    .... revenue 1..1 CodeableConcept Revenue or cost center code - must provide a value for the Institutional case
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... serviced[x] S 1..1 This is the planned or estimated date(s)s of service
    ..... servicedDate date
    ..... servicedPeriod Period
    .... Slices for location[x] 0..1 Place of service or where product was supplied
    Slice: Unordered, Open by type:$this
    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
    ..... locationCodeableConcept CodeableConcept
    ..... locationAddress Address
    ..... locationReference Reference(Location)
    ..... location[x]:locationCodeableConcept S 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    .... quantity 1..1 SimpleQuantity(4.0.1) Count of products or services
    .... net 1..1 Money Total charge amount for the service line
    .... detail S 0..* BackboneElement Drug Identification Information
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Item instance identifier
    ..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    ..... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    ... total 1..1 Money Total GFE Charges Submitted

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Claim.identifier:PLAC.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
    Claim.identifier:PLAC.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
    Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
    Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
    Claim.use Base required Use 📍4.0.1 FHIR Std.
    Claim.priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
    Claim.careTeam.role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:attending.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:attending.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:operating.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:rendering.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:referring.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.0 This IG
    Claim.supportingInfo:serviceFacility.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:drg.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.0 This IG
    Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis.type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:principal.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:admitting.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:patientReasonForVisit.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:externalcauseofinjury.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:other.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.0 This IG
    Claim.procedure:other.​type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.0 This IG
    Claim.item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
    Claim.item.location[x]:locationCodeableConcept Base required PCT GFE CMS Place of Service Value Set 📦2.0.0 This IG
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
    dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
    dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
    ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
    ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
    pct-cpt-display error Claim.item.productOrService.coding, Claim.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    Differential View

    This structure is derived from Claim

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Claim Claim
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeServiceLinkingInfo S 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    .... extension:providerEventMethodology S 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... extension:gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
    ... Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    .... identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    ..... type 1..1 CodeableConcept Description of identifier
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: PLAC
    ....... display 1..1 string Representation defined by the system
    Fixed Value: Placer Identifier
    ..... system S 0..1 uri The namespace for the identifier value
    ..... value 1..1 string The value that is unique
    ... type 1..1 CodeableConcept Category or discipline
    Required Pattern: At least the following
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: institutional
    ... use 1..1 code claim | preauthorization | predetermination
    Required Pattern: predetermination
    ... patient 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... billablePeriod S 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
    ... insurer 0..1 Reference(PCT Organization) Target
    ... provider 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    .... extension 1..* Extension Extension
    .... Slices for extension Content/Rules for all slices
    ..... extension:providerTaxonomy 1..1 CodeableConcept Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
    Binding: US Core Provider Role (NUCC) (extensible)
    ..... extension:consentForBalanceBilling S 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    ... priority 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    ... payee S 0..1 BackboneElement Recipient of benefits payable
    .... party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    ... referral
    .... extension 1..* Extension Extension
    .... Slices for extension Content/Rules for all slices
    ..... extension:referralNumber 1..1 string Referral Number
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
    ... Slices for careTeam S 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role
    .... careTeam:All Slices Content/Rules for all slices
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:attending S 0..1 BackboneElement Members of the care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: attending
    ..... qualification 1..1 CodeableConcept Practitioner credential or specialization
    .... careTeam:operating S 0..2 BackboneElement Members of the care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: operating
    .... careTeam:rendering S 0..1 BackboneElement Members of the care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... role 1..1 CodeableConcept Function within the team
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: rendering
    .... careTeam:referring S 0..1 BackboneElement Members of the care team
    ..... role 1..1 CodeableConcept Function within the team
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: referring
    ... Slices for supportingInfo S 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category
    .... supportingInfo:All Slices Content/Rules for all slices
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    .... supportingInfo:typeOfBill S 1..1 BackboneElement Supporting information
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: typeofbill
    ..... code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    .... supportingInfo:serviceFacility S 0..1 BackboneElement Service Facility
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: servicefacility
    ..... Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Open by type:$this
    ...... value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    .... supportingInfo:drg S 0..1 BackboneElement Supporting information
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: drg
    ..... code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    .... supportingInfo:pointoforigin S 0..1 BackboneElement Supporting information
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: pointoforigin
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    .... supportingInfo:admtype S 0..1 BackboneElement Supporting information
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admtype
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    ... Slices for diagnosis S 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type
    .... diagnosis:All Slices Content/Rules for all slices
    ..... type S 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    .... diagnosis:principal S 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    .... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admitting
    .... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: patientreasonforvisit
    .... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: externalcauseofinjury
    .... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
    ..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type 1..1 CodeableConcept Timing or nature of the diagnosis
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: secondary
    ... Slices for procedure S 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type
    .... procedure:All Slices Content/Rules for all slices
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... type S 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    .... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
    ..... Slices for extension Content/Rules for all slices
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1
    ..... type 1..1 CodeableConcept Category of Procedure
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    .... procedure:other S 0..24 BackboneElement Clinical procedures performed
    ..... Slices for extension Content/Rules for all slices
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... type 1..1 CodeableConcept Category of Procedure
    Required Pattern: At least the following
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: other
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    ... insurance
    .... coverage 1..1 Reference(PCT Coverage) Insurance information
    ..... Slices for extension Content/Rules for all slices
    ...... extension:dataAbsentReason S 0..1 code Coverage may be not applicable if estimate is for self-pay or uninsured
    URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
    Binding: DataAbsentReason (required)
    .... preAuthRef 0..1 string Prior authorization reference number
    ... accident
    .... location[x] 0..1 Address Where the event occurred
    ..... country 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
    Binding: Iso3166-1-2 (required)
    ... item 1..999 BackboneElement Product or service provided
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:gfeBillingProviderLineItemCtrlNum S 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    ..... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... extension:ProviderEventMethodology S 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... revenue 1..1 CodeableConcept Revenue or cost center code - must provide a value for the Institutional case
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... serviced[x] S 1..1 date, Period This is the planned or estimated date(s)s of service
    .... Slices for location[x] 0..1 CodeableConcept, Address, Reference(Location) Place of service or where product was supplied
    Slice: Unordered, Open by type:$this
    ..... location[x]:locationCodeableConcept S 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    .... quantity 1..1 SimpleQuantity(4.0.1) Count of products or services
    .... net 1..1 Money Total charge amount for the service line
    .... detail S 0..* BackboneElement Drug Identification Information
    ..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    ..... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    ... total 1..1 Money Total GFE Charges Submitted

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Claim.priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    Claim.careTeam.role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.0 This IG
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.0 This IG
    Claim.diagnosis.type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.0 This IG
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.0 This IG
    Claim.accident.location[x].​country Base required Iso 3166 Part 1: 2 Letter Codes 📦4.0.1 FHIR Std.
    Claim.item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    Claim.item.location[x]:locationCodeableConcept Base required PCT GFE CMS Place of Service Value Set 📦2.0.0 This IG
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    pct-cpt-display error Claim.item.productOrService.coding, Claim.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    Snapshot View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.
    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    This profile does not constrain the narrative in regard to content, language, or traceability to data elements
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeServiceLinkingInfo S 0..1 (Complex) GFE Service Linking Information.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeServiceLinkingInfo
    .... extension:providerEventMethodology S 0..1 string Provider event collection methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... extension:gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the providers estimate, e.g. application of sliding scale for self-pay/uninsured patients
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... Slices for identifier 1..* Identifier Business Identifier for claim
    Slice: Unordered, Open by value:type
    .... identifier:PLAC 1..1 Identifier Provider Assigned Identifier for GFE Claim
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    ..... type Σ 1..1 CodeableConcept Description of identifier
    Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: PLAC
    ....... display 1..1 string Representation defined by the system
    Fixed Value: Placer Identifier
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... system SΣ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value Σ 1..1 string The value that is unique
    Example General: 123456
    ..... period Σ 0..1 Period Time period when id is/was valid for use
    ..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
    ... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
    Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
    ... type Σ 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
    Required Pattern: At least the following
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
    ..... version 0..1 string Version of the system - if relevant
    ..... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: institutional
    ..... display 0..1 string Representation defined by the system
    ..... userSelected 0..1 boolean If this coding was chosen directly by the user
    .... text 0..1 string Plain text representation of the concept
    ... subType 0..1 CodeableConcept More granular claim type
    Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
    ... use Σ 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
    Required Pattern: predetermination
    ... patient Σ 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... billablePeriod SΣ 0..1 Period Relevant time frame for the claim. This is per claim, whereas a planned period of service can span multiple claims.
    ... created Σ 1..1 dateTime Resource creation date
    ... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
    ... insurer Σ 0..1 Reference(PCT Organization) Target
    ... provider Σ 1..1 Reference(PCT Organization) Billing provider - party responsible for the GFE
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:providerTaxonomy 1..1 CodeableConcept Provider taxonomy codes consisting of NUCC Health Care Provider Taxonomy Code Set for providers
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerTaxonomy
    Binding: US Core Provider Role (NUCC) (extensible)
    ..... extension:consentForBalanceBilling S 0..1 boolean Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling
    .... reference 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: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... priority Σ 1..1 CodeableConcept Desired processing ugency
    Binding: ProcessPriorityCodes (required)
    ... fundsReserve 0..1 CodeableConcept For whom to reserve funds
    Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
    ... related 0..* BackboneElement Prior or corollary claims
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... claim 0..1 Reference(Claim) Reference to the related claim
    .... relationship 0..1 CodeableConcept How the reference claim is related
    Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
    .... reference 0..1 Identifier File or case reference
    ... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
    ... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
    ... payee S 0..1 BackboneElement Recipient of benefits payable
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... type 1..1 CodeableConcept Category of recipient
    Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    .... party 0..1 Reference(PCT Practitioner | PCT Organization) Recipient reference
    ... referral 0..1 Reference(ServiceRequest) Treatment referral
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:referralNumber 1..1 string Referral Number
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/referralNumber
    .... reference 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: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    .... display Σ 0..1 string Text alternative for the resource
    ... facility 0..1 Reference(Location) Servicing facility
    ... Slices for careTeam S 0..* BackboneElement Members of the care team
    Slice: Unordered, Open by value:role
    .... careTeam:All Slices Content/Rules for all slices
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:attending S 0..1 BackboneElement Members of the care team
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: attending
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 1..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:operating S 0..2 BackboneElement Members of the care team
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: operating
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:rendering S 0..1 BackboneElement Members of the care team
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: rendering
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    .... careTeam:referring S 0..1 BackboneElement Members of the care team
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Order of care team
    ..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
    ..... responsible 0..1 boolean Indicator of the lead practitioner
    ..... role 1..1 CodeableConcept Function within the team
    Binding: PCT Care Team Role Value Set (required)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
    ....... version 1..1 string Version of the system - if relevant
    Fixed Value: 1.0.1
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: referring
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... qualification 0..1 CodeableConcept Practitioner credential or specialization
    Binding: US Core Provider Role (NUCC) (required)
    ... Slices for supportingInfo S 1..* BackboneElement Supporting information
    Slice: Unordered, Open by value:category
    .... supportingInfo:All Slices Content/Rules for all slices
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    ..... code 0..1 CodeableConcept Type of information
    Binding: ExceptionCodes (example): The valuset used for additional information codes.
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:typeOfBill S 1..1 BackboneElement Supporting information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: typeofbill
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 1..1 CodeableConcept Type of information
    Binding: PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set (required)
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:serviceFacility S 0..1 BackboneElement Service Facility
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: servicefacility
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: ExceptionCodes (example): The valuset used for additional information codes.
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... Slices for value[x] 1..1 Reference(Resource) Data to be provided
    Slice: Unordered, Closed by type:$this
    ...... value[x]:valueReference 1..1 Reference(PCT Organization) Data to be provided
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:drg S 0..1 BackboneElement Supporting information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: drg
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: US Claim DRG Codes (required)
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:pointoforigin S 0..1 BackboneElement Supporting information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: pointoforigin
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Point Of Origin (required)
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    .... supportingInfo:admtype S 0..1 BackboneElement Supporting information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Information instance identifier
    ..... category 1..1 CodeableConcept Classification of the supplied information
    Binding: PCT Supporting Info Type Value Set (extensible)
    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSupportingInfoType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admtype
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... code 0..1 CodeableConcept Type of information
    Binding: NUBC Priority (Type) of Admission or Visit (required)
    ..... timing[x] 0..1 When it occurred
    ...... timingDate date
    ...... timingPeriod Period
    ..... value[x] 0..1 Data to be provided
    ...... valueBoolean boolean
    ...... valueString string
    ...... valueQuantity Quantity
    ...... valueAttachment Attachment
    ...... valueReference Reference(Resource)
    ..... reason 0..1 CodeableConcept Explanation for the information
    Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
    ... Slices for diagnosis S 0..* BackboneElement Pertinent diagnosis information
    Slice: Unordered, Open by value:type
    .... diagnosis:All Slices Content/Rules for all slices
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 Nature of illness or problem
    Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
    ...... diagnosisCodeableConcept CodeableConcept
    ...... diagnosisReference Reference(Condition)
    ..... type S 0..* CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:principal S 0..1 BackboneElement Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    Required Pattern: 1
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: admitting
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: patientreasonforvisit
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: externalcauseofinjury
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    .... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Diagnosis instance identifier
    ..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
    Binding: PCT ICD-10 Diagnostic Codes (required)
    ..... type S 1..1 CodeableConcept Timing or nature of the diagnosis
    Binding: Diagnosis Type Codes (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: secondary
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... onAdmission 0..1 CodeableConcept Present on admission
    Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
    ..... packageCode 0..1 CodeableConcept Package billing code
    Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
    ... Slices for procedure S 0..* BackboneElement Clinical procedures performed
    Slice: Unordered, Open by value:type
    .... procedure:All Slices Content/Rules for all slices
    ..... id 0..1 string Unique id for inter-element referencing
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    ..... type S 0..* CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)
    ..... date 0..1 dateTime When the procedure was performed
    ..... procedure[x] 1..1 Specific clinical procedure
    Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
    ...... procedureCodeableConcept CodeableConcept
    ...... procedureReference Reference(Procedure)
    ..... udi 0..* Reference(Device) Unique device identifier
    .... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
    ..... id 0..1 string Unique id for inter-element referencing
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    Required Pattern: 1
    ..... type S 1..1 CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: principal
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... date 0..1 dateTime When the procedure was performed
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: ICD-10 Procedure Codes (required)
    ..... udi 0..* Reference(Device) Unique device identifier
    .... procedure:other S 0..24 BackboneElement Clinical procedures performed
    ..... id 0..1 string Unique id for inter-element referencing
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Procedure instance identifier
    ..... type S 1..1 CodeableConcept Category of Procedure
    Binding: PCT Procedure Type Value Set (required)

    Required Pattern: At least the following
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... coding 1..* Coding Code defined by a terminology system
    Fixed Value: (Complex)
    ....... id 0..1 string Unique id for inter-element referencing
    ....... extension 0..* Extension Additional content defined by implementations
    ....... system 1..1 uri Identity of the terminology system
    Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: other
    ....... display 0..1 string Representation defined by the system
    ....... userSelected 0..1 boolean If this coding was chosen directly by the user
    ...... text 0..1 string Plain text representation of the concept
    ..... date 0..1 dateTime When the procedure was performed
    ..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
    Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
    ..... udi 0..* Reference(Device) Unique device identifier
    ... insurance Σ 1..* BackboneElement Patient insurance information
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence Σ 1..1 positiveInt Insurance instance identifier
    .... focal Σ 1..1 boolean Coverage to be used for adjudication
    .... identifier 0..1 Identifier Pre-assigned Claim number
    .... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
    ..... id 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
    ...... extension:dataAbsentReason S 0..1 code Coverage may be not applicable if estimate is for self-pay or uninsured
    URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
    Binding: DataAbsentReason (required)
    ..... reference 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: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    ..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
    ..... display Σ 0..1 string Text alternative for the resource
    .... businessArrangement 0..1 string Additional provider contract number
    .... preAuthRef 0..1 string Prior authorization reference number
    .... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
    ... accident 0..1 BackboneElement Details of the event
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... date 1..1 date When the incident occurred
    .... type 0..1 CodeableConcept The nature of the accident
    Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
    .... location[x] 0..1 Address Where the event occurred
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 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: AddressUse (required): The use of an address.
    Example General: home
    ..... type Σ 0..1 code postal | physical | both
    Binding: AddressType (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
    ..... 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
    ..... city Σ 0..1 string Name of city, town etc.
    Example General: Erewhon
    ..... district Σ 0..1 string District name (aka county)
    Example General: Madison
    ..... state Σ 0..1 string Sub-unit of country (abbreviations ok)
    ..... postalCode 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)
    Binding: Iso3166-1-2 (required)
    ..... period Σ 0..1 Period Time period when address was/is in use
    Example General: {"start":"2010-03-23","end":"2010-07-01"}
    ... item 1..999 BackboneElement Product or service provided
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:gfeBillingProviderLineItemCtrlNum S 0..1 Identifier Extension
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeBillingProviderLineItemCtrlNum
    ..... extension:serviceDescription 1..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    ..... extension:ProviderEventMethodology S 0..1 string Provider Event Methodology
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/providerEventMethodology
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence 1..1 positiveInt Item instance identifier
    .... careTeamSequence 0..* positiveInt Applicable careTeam members
    .... diagnosisSequence 0..* positiveInt Applicable diagnoses
    .... procedureSequence 0..* positiveInt Applicable procedures
    .... informationSequence 0..* positiveInt Applicable exception and supporting information
    .... revenue 1..1 CodeableConcept Revenue or cost center code - must provide a value for the Institutional case
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    ..... text Σ 0..1 string Plain text representation of the concept
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    ..... text Σ 0..1 string Plain text representation of the concept
    .... programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    .... serviced[x] S 1..1 This is the planned or estimated date(s)s of service
    ..... servicedDate date
    ..... servicedPeriod Period
    .... Slices for location[x] 0..1 Place of service or where product was supplied
    Slice: Unordered, Open by type:$this
    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
    ..... locationCodeableConcept CodeableConcept
    ..... locationAddress Address
    ..... locationReference Reference(Location)
    ..... location[x]:locationCodeableConcept S 0..1 CodeableConcept Place of service or where product was supplied
    Binding: PCT GFE CMS Place of Service Value Set (required)
    .... quantity 1..1 SimpleQuantity(4.0.1) Count of products or services
    .... unitPrice 0..1 Money Fee, charge or cost per item
    .... factor 0..1 decimal Price scaling factor
    .... net 1..1 Money Total charge amount for the service line
    .... udi 0..* Reference(Device) Unique device identifier
    .... bodySite 0..1 CodeableConcept Anatomical location
    Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
    .... subSite 0..* CodeableConcept Anatomical sub-location
    Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
    .... encounter 0..* Reference(Encounter) Encounters related to this billed item
    .... detail S 0..* BackboneElement Drug Identification Information
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... sequence 1..1 positiveInt Item instance identifier
    ..... revenue 0..1 CodeableConcept Revenue or cost center code
    Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
    ..... category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    ..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: PCT GFE Item NDC Value Set (required)
    ..... modifier 0..* CodeableConcept Service/Product billing modifiers
    Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
    ..... programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    ..... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    ..... unitPrice 0..1 Money Fee, charge or cost per item
    ..... factor 0..1 decimal Price scaling factor
    ..... net 0..1 Money Total item cost
    ..... udi 0..* Reference(Device) Unique device identifier
    ..... subDetail 0..* BackboneElement Product or service provided
    ...... id 0..1 string Unique id for inter-element referencing
    ...... extension 0..* Extension Additional content defined by implementations
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... sequence 1..1 positiveInt Item instance identifier
    ...... revenue 0..1 CodeableConcept Revenue or cost center code
    Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
    ...... category 0..1 CodeableConcept Benefit classification
    Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
    ...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: USCLSCodes (example): Allowable service and product codes.
    ...... modifier 0..* CodeableConcept Service/Product billing modifiers
    Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
    ...... programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    ...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
    ...... unitPrice 0..1 Money Fee, charge or cost per item
    ...... factor 0..1 decimal Price scaling factor
    ...... net 0..1 Money Total item cost
    ...... udi 0..* Reference(Device) Unique device identifier
    ... total 1..1 Money Total GFE Charges Submitted

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
    Claim.identifier:PLAC.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
    Claim.identifier:PLAC.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
    Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
    Claim.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
    Claim.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
    Claim.use Base required Use 📍4.0.1 FHIR Std.
    Claim.provider.type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Claim.priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    Claim.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
    Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
    Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
    Claim.referral.type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Claim.careTeam.role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam.qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:attending.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:attending.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:operating.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:operating.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:rendering.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:rendering.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.careTeam:referring.​role Base required PCT Care Team Role Value Set 📦2.0.0 This IG
    Claim.careTeam:referring.​qualification Base required US Core Provider Role (NUCC) 📦3.1.1 US Core v3.1
    Claim.supportingInfo.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo.​code Base example Exception Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:typeOfBill.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​code Base required PCT GFE NUBC Uniform Billing (UB-04) Type of Bill Value Set 📦2.0.0 This IG
    Claim.supportingInfo:typeOfBill.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:serviceFacility.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:serviceFacility.​code Base example Exception Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:serviceFacility.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:drg.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:drg.​code Base required US Claim DRG Codes 📦2.0.0 This IG
    Claim.supportingInfo:drg.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:pointoforigin.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​code Base required NUBC Point Of Origin 📦2.0.0 This IG
    Claim.supportingInfo:pointoforigin.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.supportingInfo:admtype.​category Base extensible PCT Supporting Info Type Value Set 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​code Base required NUBC Priority (Type) of Admission or Visit 📦2.0.0 This IG
    Claim.supportingInfo:admtype.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis.type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:principal.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:principal.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:principal.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:principal.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:admitting.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:admitting.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:admitting.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:admitting.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:patientReasonForVisit.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:patientReasonForVisit.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:patientReasonForVisit.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:patientReasonForVisit.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:externalcauseofinjury.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:externalcauseofinjury.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:externalcauseofinjury.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:externalcauseofinjury.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:other.​diagnosis[x] Base required PCT ICD-10 Diagnostic Codes 📦2.0.0 This IG
    Claim.diagnosis:other.​type Base required Diagnosis Type Codes 📦1.0.0 THO v6.5
    Claim.diagnosis:other.​onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    Claim.diagnosis:other.​packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    Claim.procedure.type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    Claim.procedure:principal.​type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:principal.​procedure[x] Base required ICD-10 Procedure Codes 📦2.0.0 This IG
    Claim.procedure:other.​type Base required PCT Procedure Type Value Set 📦2.0.0 This IG
    Claim.procedure:other.​procedure[x] Base required PCT CMS HCPCS and AMA CPT Procedure Surgical Codes 📦2.0.0 This IG
    Claim.insurance.coverage.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
    Claim.accident.type Base extensible ActIncidentCode 📍3.0.0 THO v6.5
    Claim.accident.location[x].​use Base required AddressUse 📍4.0.1 FHIR Std.
    Claim.accident.location[x].​type Base required AddressType 📍4.0.1 FHIR Std.
    Claim.accident.location[x].​country Base required Iso 3166 Part 1: 2 Letter Codes 📦4.0.1 FHIR Std.
    Claim.item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
    Claim.item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    Claim.item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
    Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
    Claim.item.location[x]:locationCodeableConcept Base required PCT GFE CMS Place of Service Value Set 📦2.0.0 This IG
    Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
    Claim.item.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.productOrService Base required PCT GFE Item NDC Value Set 📦2.0.0 This IG
    Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
    Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
    dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
    dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice Claim A resource should have narrative for robust management text.`div`.exists()
    ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
    ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
    pct-cpt-display error Claim.item.productOrService.coding, Claim.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    This structure is derived from Claim

    Summary

    Mandatory: 17 elements(17 nested mandatory elements)
    Must-Support: 38 elements

    Structures

    This structure refers to these other structures:

    Extensions

    This structure refers to these extensions:

    Slices

    This structure defines the following Slices:

    • The element 1 is sliced based on the value of Claim.identifier
    • The element 1 is sliced based on the value of Claim.careTeam
    • The element 1 is sliced based on the value of Claim.supportingInfo
    • The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
    • The element 1 is sliced based on the value of Claim.diagnosis
    • The element 1 is sliced based on the value of Claim.procedure
    • The element 1 is sliced based on the value of Claim.item.location[x]

    Maturity: 2

     

    Other representations of profile: CSV, Excel, Schematron