abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisher- Values Differ
purposestatustitletypeurlversion- Values Differ
| Left: | PCT Good Faith Estimate Professional (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional) |
| Right: | PCT Good Faith Estimate Professional (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional) |
| Error | StructureDefinition.version | Values for version differ: '1.0.0' vs '1.1.0' |
| Information | StructureDefinition.date | Values for date differ: '2023-03-30T13:34:22+00:00' vs '2024-01-03T18:32:02+00:00' |
| Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 International - Financial Management Work Group' vs 'HL7 International / Financial Management' |
| Information | StructureDefinition.comment | Values for comment differ: 'The definition of Address states that 'address is intended to describe postal addresses, not physical locations'. However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the [Location](http://hl7.org/fhir/R4/location.html#) resource).' vs 'The definition of Address states that 'address is intended to describe postal addresses, not physical locations'. However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the [Location](location.html#) resource).' |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/Claim | ||
| copyright | |||
| date | 2023-03-30T13:34:22+00:00 | 2024-01-03T18:32:02+00:00 |
|
| description | PCT Good Faith Estimate Professional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for a professional GFE submission. | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | PCTGFEProfessional | ||
| publisher | HL7 International - Financial Management Work Group | HL7 International / Financial Management |
|
| purpose | |||
| status | active | ||
| title | PCT Good Faith Estimate Professional | ||
| type | Claim | ||
| url | http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-professional | ||
| version | 1.0.0 | 1.1.0 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | L Type | L Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||||||||
 id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |||||||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
 Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
| Slices for identifier | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by pattern:type | 1..* | Identifier | Business Identifier for claim Slice: Unordered, Open by pattern:type | |||||||||||
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||
| type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"professional"}]} | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"professional"}]} | |||||||||
| subType | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | |||||||||||
| use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination | |||||||||
| patient | Σ | 1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services | Σ | 1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services | |||||||||
| billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim | Σ | 0..1 | Period | Relevant time frame for the claim | |||||||||
| created | Σ | 1..1 | dateTime | Resource creation date | Σ | 1..1 | dateTime | Resource creation date | |||||||||
| enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||||||||
| insurer | Σ | 1..1 | Reference(PCT Organization) | Target | Σ | 1..1 | Reference(PCT Organization) | Target | |||||||||
 provider | Σ | 1..1 | Reference(PCT Organization | PCT Practitioner) | Billing provider - party responsible for the GFE | Σ | 1..1 | Reference(PCT Organization | PCT Practitioner) | Billing provider - party responsible for the GFE | |||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
| reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | |||||||||
| type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | |||||||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | |||||||||
| display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource | |||||||||
| priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ?? (required) | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ?? (required) | |||||||||
| fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
| related | 0..* | BackboneElement | Prior or corollary claims | 0..* | BackboneElement | Prior or corollary claims | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| claim | 0..1 | Reference(Claim) | Reference to the related claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||||||||
| relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. | |||||||||||
| reference | 0..1 | Identifier | File or case reference | 0..1 | Identifier | File or case reference | |||||||||||
| prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||||||||
| originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||||||||
| payee | S | 0..1 | BackboneElement | Recipient of benefits payable | S | 0..1 | BackboneElement | Recipient of benefits payable | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. | |||||||||||
| party | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | 0..1 | Reference(PCT Practitioner | PCT Organization) | Recipient reference | |||||||||||
| referral | 0..1 | Reference(ServiceRequest) | Treatment referral | 0..1 | Reference(ServiceRequest) | Treatment referral | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
| reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | |||||||||
| type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | |||||||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | |||||||||
| display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource | |||||||||
| facility | 0..1 | Reference(Location) | Servicing facility | 0..1 | Reference(Location) | Servicing facility | |||||||||||
| Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by pattern:role | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Order of care team | 1..1 | positiveInt | Order of care team | |||||||||||
| provider | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization | |||||||||||
| responsible | 0..1 | boolean | Indicator of the lead practitioner | 0..1 | boolean | Indicator of the lead practitioner | |||||||||||
| role | 1..1 | CodeableConcept | Function within the team Binding: ?? (required) | 1..1 | CodeableConcept | Function within the team Binding: ?? (required) | |||||||||||
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (required) | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (required) | |||||||||||
| Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Information instance identifier | 1..1 | positiveInt | Information instance identifier | |||||||||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) | |||||||||||
| code | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | |||||||||||
| timing[x] | 0..1 | date, Period | When it occurred | 0..1 | date, Period | When it occurred | |||||||||||
| value[x] | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | |||||||||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | |||||||||||
| Slices for diagnosis | S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type | S | 1..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by pattern:type | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | 1..1 | positiveInt | Diagnosis instance identifier | |||||||||||
| diagnosis[x] | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. | |||||||||||
| type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required) | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required) | |||||||||
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | |||||||||||
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | |||||||||||
| Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by pattern:type | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Procedure instance identifier | 1..1 | positiveInt | Procedure instance identifier | |||||||||||
| type | S | 0..* | CodeableConcept | Category of Procedure Binding: ?? (required) | S | 0..* | CodeableConcept | Category of Procedure Binding: ?? (required) | |||||||||
| date | 0..1 | dateTime | When the procedure was performed | 0..1 | dateTime | When the procedure was performed | |||||||||||
| procedure[x] | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| insurance | Σ | 1..* | BackboneElement | Patient insurance information | Σ | 1..* | BackboneElement | Patient insurance information | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier | Σ | 1..1 | positiveInt | Insurance instance identifier | |||||||||
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication | Σ | 1..1 | boolean | Coverage to be used for adjudication | |||||||||
| identifier | 0..1 | Identifier | Pre-assigned Claim number | 0..1 | Identifier | Pre-assigned Claim number | |||||||||||
| coverage | Σ | 1..1 | Reference(PCT Coverage) | Insurance information | Σ | 1..1 | Reference(PCT Coverage) | Insurance information | |||||||||
| businessArrangement | 0..1 | string | Additional provider contract number | 0..1 | string | Additional provider contract number | |||||||||||
| preAuthRef | 0..2 | string | Prior authorization reference number | 0..2 | string | Prior authorization reference number | |||||||||||
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||||||||
| accident | 0..1 | BackboneElement | Details of the event | 0..1 | BackboneElement | Details of the event | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| date | 1..1 | date | When the incident occurred | 1..1 | date | When the incident occurred | |||||||||||
| type | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | |||||||||||
 location[x] | 0..1 | Address | Where the event occurred | 0..1 | Address | Where the event occurred | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: ?? (required): The use of an address. Example General: home | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: ?? (required): The use of an address. Example General: home | |||||||||
| type | Σ | 0..1 | code | postal | physical | both Binding: ?? (required): The type of an address (physical / postal). Example General: both | Σ | 0..1 | code | postal | physical | both Binding: ?? (required): The type of an address (physical / postal). Example General: both | |||||||||
| text | Σ | 0..1 | string | Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132 | Σ | 0..1 | string | Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132 | |||||||||
| line | Σ | 0..* | string | Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street | Σ | 0..* | string | Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street | |||||||||
| city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon | |||||||||
| district | Σ | 0..1 | string | District name (aka county) Example General: Madison | Σ | 0..1 | string | District name (aka county) Example General: Madison | |||||||||
| state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok) | Σ | 0..1 | string | Sub-unit of country (abbreviations ok) | |||||||||
| postalCode | Σ | 0..1 | string | Postal code for area Example General: 9132 | Σ | 0..1 | string | Postal code for area Example General: 9132 | |||||||||
| country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: ?? (required) | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: ?? (required) | |||||||||
| period | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"} | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"} | |||||||||
| item | 1..50 | BackboneElement | Product or service provided | 1..50 | BackboneElement | Product or service provided | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
| careTeamSequence | S | 0..* | positiveInt | Applicable careTeam members | S | 0..* | positiveInt | Applicable careTeam members | |||||||||
| diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | 0..* | positiveInt | Applicable diagnoses | |||||||||||
| procedureSequence | 0..* | positiveInt | Applicable procedures | 0..* | positiveInt | Applicable procedures | |||||||||||
| informationSequence | 0..* | positiveInt | Applicable exception and supporting information | 0..* | positiveInt | Applicable exception and supporting information | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | |||||||||||
| modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: ?? (required) | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: ?? (required) | |||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| serviced[x] | S | 1..1 | date, Period | This is the planned or estimated date(s)s of service | S | 1..1 | date, Period | This is the planned or estimated date(s)s of service | |||||||||
| Slices for location[x] | 1..1 | CodeableConcept | Place of service or where product was supplied Slice: Unordered, Closed by type:$this Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: ?? (required) | |||||||||||
| quantity | 1..1 | ?? | Count of products or services | 1..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 1..1 | Money | Fee, charge or cost per item | 1..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 1..1 | Money | Total charge amount for the service line | 1..1 | Money | Total charge amount for the service line | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |||||||||||
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |||||||||||
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||||||||
| detail | S | 0..* | BackboneElement | Drug Identification Information | S | 0..* | BackboneElement | Drug Identification Information | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| quantity | S | 0..1 | ?? | Count of products or services | S | 0..1 | ?? | Count of products or services | |||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| subDetail | 0..* | BackboneElement | Product or service provided | 0..* | BackboneElement | Product or service provided | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| total | 1..1 | Money | Total GFE Charges Submitted | 1..1 | Money | Total GFE Charges Submitted | |||||||||||
| Documentation for this format | |||||||||||||||||