STU 2 Ballot

This page is part of the Quality Improvement Core Framework (v1.6.0: STU 2 Ballot 1) based on FHIR v1.6.0. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

D.4.1 StructureDefinition: qicore-claim

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is: 

http://hl7.org/fhir/qicore/StructureDefinition/qicore-claim

This profile was published on Fri Jul 15 00:00:00 AEST 2016 as a draft by Health Level Seven International (Clinical Quality Information - QICore).

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim I0..*Claim, Pre-determination or Pre-authorization
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
... id ∑0..1idLogical id of this artifact
... meta ∑0..1MetaMetadata about the resource
... implicitRules ?!∑0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierClaim number
... status ?!∑1..1codeactive | cancelled | draft | entered-in-error
Binding: ClaimStatus (required)
... type 1..1CodingType or discipline
Binding: Example Claim Type Codes (required)
... subType 0..*CodingFiner grained claim type information
Binding: Example Claim SubType Codes (example)
... ruleset 0..1CodingCurrent specification followed
Binding: Ruleset Codes (example)
... originalRuleset 0..1CodingOriginal specification followed
Binding: Ruleset Codes (example)
... created S0..1dateTimeCreation date
... billablePeriod 0..1PeriodPeriod for charge submission
... insurer[x] 0..1Identifier, Reference(Organization)Target
... provider[x] 0..1Identifier, Reference(Practitioner)Responsible provider
... organization[x] 0..1Identifier, Reference(Organization)Responsible organization
... use 0..1codecomplete | proposed | exploratory | other
Binding: Use (required)
... priority 0..1CodingDesired processing priority
Binding: Priority Codes (example)
... fundsReserve 0..1CodingFunds requested to be reserved
Binding: Funds Reservation Codes (example)
... enterer[x] 0..1Identifier, Reference(Practitioner)Author
... facility[x] 0..1Identifier, Reference(Location)Servicing Facility
... related 0..*BackboneElementRelated Claims which may be revelant to processing this claimn
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... claim[x] 0..1Identifier, Reference(Claim)Reference to the related claim
.... relationship 0..1CodingHow the reference claim is related
Binding: Example Related Claim Relationship Codes (example)
.... reference 0..1IdentifierRelated file or case reference
... prescription[x] 0..1Identifier, Reference(MedicationOrder), Reference(VisionPrescription)Prescription
... originalPrescription[x] 0..1Identifier, Reference(MedicationOrder)Original Prescription
... payee 0..1BackboneElementParty to be paid any benefits payable
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... type 1..1CodingType of party: Subscriber, Provider, other
Binding: Payee Type Codes (example)
.... resourceType 0..1Codingorganization | patient | practitioner | relatedperson
Binding: PayeeResourceType (example)
.... party[x] 0..1Reference(Profile qicore-patient | Profile qicore-organization | Profile qicore-practitioner | Profile qicore-relatedperson)Party to receive the payable
... referralReference 0..1Reference(Profile qicore-referralrequest)Treatment Referral
... information 0..*BackboneElement
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... category S1..1CodingCategory of information
Binding: Claim Information Category Codes (example)
.... code S0..1CodingType of information
Binding: Exception Codes (example)
.... timing[x] 0..1date, PeriodWhen it occurred
.... value[x] 0..1string, QuantityAdditional Data
... diagnosis 0..*BackboneElementDiagnosis
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of diagnosis
.... diagnosis 1..1CodingPatient's diagnosis
Binding: ICD-10 Codes (example)
.... type 0..1CodingType of Diagnosis
Binding: Example Diagnosis Type Codes (example)
.... drg 0..1CodingDiagnosis Related Group
Binding: Example Diagnosis Related Group Codes (example)
... procedure 0..*BackboneElementProcedures performed
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntProcedure sequence for reference
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Coding, Reference(Procedure)Patient's list of procedures performed
Binding: ICD-10 Procedure Codes (example)
... patient[x] 1..1Identifier, Reference(Patient)The subject of the Products and Services
... coverage 0..*BackboneElementInsurance or medical plan
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance identifier
.... focal 1..1booleanIs the focal Coverage
.... coverage[x] 1..1Identifier, Reference(Coverage)Insurance information
.... businessArrangement 0..1stringBusiness agreement
.... preAuthRef 0..*stringPre-Authorization/Determination Reference
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
.... originalRuleset 0..1CodingOriginal version
Binding: Ruleset Codes (example)
... accident 0..1BackboneElement
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... date 1..1dateWhen the accident occurred see information codes see information codes
.... type 0..1CodingThe nature of the accident
Binding: ActIncidentCode (required)
.... location[x] 0..1Address, Reference(Location)Accident Place
... employmentImpacted 0..1PeriodPeriod unable to work
... hospitalization 0..1PeriodPeriod in hospital
... item S0..*BackboneElementGoods and Services
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance
.... careTeam 0..*BackboneElement
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
..... provider[x] 1..1Reference(Profile qicore-practitioner | Profile qicore-organization)Provider individual or organization
..... responsible 0..1booleanBilling provider
..... role 0..1CodingRole on the team
Binding: Claim Care Team Role Codes (example)
..... qualification 0..1CodingType, classification or Specialization
Binding: Example Provider Qualification Codes (example)
.... diagnosisLinkId 0..*positiveIntApplicable diagnoses
.... revenue 0..1CodingRevenue or cost center code
Binding: Example Revenue Center Codes (example)
.... category 0..1CodingType of service or product
Binding: Benefit SubCategory Codes (example)
.... service S0..1CodingBilling Code
Binding: USCLS Codes (example)
.... modifier 0..*CodingService/Product billing modifiers
Binding: Modifier type Codes (example)
.... programCode 0..*CodingProgram specific reason for item inclusion
Binding: Example Program Reason Codes (example)
.... serviced[x] S0..1date, PeriodDate or dates of Service
.... locationReference 0..1Reference(Profile qicore-location)Place of service
Binding: Example Service Place Codes (example)
.... quantity 0..1SimpleQuantityCount of Products or Services
.... unitPrice 0..1MoneyFee, charge or cost per point
.... factor 0..1decimalPrice scaling factor
.... points 0..1decimalDifficulty scaling factor
.... net 0..1MoneyTotal item cost
.... udi 0..*Reference(Profile qicore-device)Unique Device Identifier
.... bodySite 0..1CodingService Location
Binding: Oral Site Codes (example)
.... subSite 0..*CodingService Sub-location
Binding: Surface Codes (example)
.... detail 0..*BackboneElementAdditional items
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
..... sequence 1..1positiveIntService instance
..... revenue 0..1CodingRevenue or cost center code
Binding: Example Revenue Center Codes (example)
..... category 0..1CodingType of service or product
Binding: Benefit SubCategory Codes (example)
..... service 0..1CodingBilling Code
Binding: USCLS Codes (example)
..... modifier 0..*CodingService/Product billing modifiers
Binding: Modifier type Codes (example)
..... programCode 0..*CodingProgram specific reason for item inclusion
Binding: Example Program Reason Codes (example)
..... quantity 0..1SimpleQuantityCount of Products or Services
..... unitPrice 0..1MoneyFee, charge or cost per point
..... factor 0..1decimalPrice scaling factor
..... points 0..1decimalDifficulty scaling factor
..... net 0..1MoneyTotal additional item cost
..... udi 0..*Reference(Profile qicore-device)Unique Device Identifier
..... subDetail 0..*BackboneElementAdditional items
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
...... sequence 1..1positiveIntService instance
...... revenue 0..1CodingRevenue or cost center code
Binding: Example Revenue Center Codes (example)
...... category 0..1CodingType of service or product
Binding: Benefit SubCategory Codes (example)
...... service 0..1CodingBilling Code
Binding: USCLS Codes (example)
...... modifier 0..*CodingService/Product billing modifiers
Binding: Modifier type Codes (example)
...... programCode 0..*CodingProgram specific reason for item inclusion
Binding: Example Program Reason Codes (example)
...... quantity 0..1SimpleQuantityCount of Products or Services
...... unitPrice 0..1MoneyFee, charge or cost per point
...... factor 0..1decimalPrice scaling factor
...... points 0..1decimalDifficulty scaling factor
...... net 0..1MoneyNet additional item cost
...... udi 0..*Reference(Profile qicore-device)Unique Device Identifier
.... prosthesis 0..1BackboneElementProsthetic details
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
..... initial 0..1booleanIs this the initial service
..... priorDate 0..1dateInitial service Date
..... priorMaterial 0..1CodingProsthetic Material
Binding: Oral Prostho Material type Codes (example)
... total 0..1MoneyTotal claim cost
... missingTeeth 0..*BackboneElementOnly if type = oral
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... tooth 1..1CodingTooth Code
Binding: Teeth Codes (example)
.... reason 0..1CodingIndicates whether it was extracted or other reason
Binding: Missing Tooth Reason Codes (example)
.... extractionDate 0..1dateDate tooth was extracted if known

doco Documentation for this format

yet to be done: Xml template

yet to be done: Json template

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim I0..*Claim, Pre-determination or Pre-authorization
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
... id ∑0..1idLogical id of this artifact
... meta ∑0..1MetaMetadata about the resource
... implicitRules ?!∑0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierClaim number
... status ?!∑1..1codeactive | cancelled | draft | entered-in-error
Binding: ClaimStatus (required)
... type 1..1CodingType or discipline
Binding: Example Claim Type Codes (required)
... subType 0..*CodingFiner grained claim type information
Binding: Example Claim SubType Codes (example)
... ruleset 0..1CodingCurrent specification followed
Binding: Ruleset Codes (example)
... originalRuleset 0..1CodingOriginal specification followed
Binding: Ruleset Codes (example)
... created S0..1dateTimeCreation date
... billablePeriod 0..1PeriodPeriod for charge submission
... insurer[x] 0..1Identifier, Reference(Organization)Target
... provider[x] 0..1Identifier, Reference(Practitioner)Responsible provider
... organization[x] 0..1Identifier, Reference(Organization)Responsible organization
... use 0..1codecomplete | proposed | exploratory | other
Binding: Use (required)
... priority 0..1CodingDesired processing priority
Binding: Priority Codes (example)
... fundsReserve 0..1CodingFunds requested to be reserved
Binding: Funds Reservation Codes (example)
... enterer[x] 0..1Identifier, Reference(Practitioner)Author
... facility[x] 0..1Identifier, Reference(Location)Servicing Facility
... related 0..*BackboneElementRelated Claims which may be revelant to processing this claimn
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... claim[x] 0..1Identifier, Reference(Claim)Reference to the related claim
.... relationship 0..1CodingHow the reference claim is related
Binding: Example Related Claim Relationship Codes (example)
.... reference 0..1IdentifierRelated file or case reference
... prescription[x] 0..1Identifier, Reference(MedicationOrder), Reference(VisionPrescription)Prescription
... originalPrescription[x] 0..1Identifier, Reference(MedicationOrder)Original Prescription
... payee 0..1BackboneElementParty to be paid any benefits payable
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... type 1..1CodingType of party: Subscriber, Provider, other
Binding: Payee Type Codes (example)
.... resourceType 0..1Codingorganization | patient | practitioner | relatedperson
Binding: PayeeResourceType (example)
.... party[x] 0..1Reference(Profile qicore-patient | Profile qicore-organization | Profile qicore-practitioner | Profile qicore-relatedperson)Party to receive the payable
... referralReference 0..1Reference(Profile qicore-referralrequest)Treatment Referral
... information 0..*BackboneElement
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... category S1..1CodingCategory of information
Binding: Claim Information Category Codes (example)
.... code S0..1CodingType of information
Binding: Exception Codes (example)
.... timing[x] 0..1date, PeriodWhen it occurred
.... value[x] 0..1string, QuantityAdditional Data
... diagnosis 0..*BackboneElementDiagnosis
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of diagnosis
.... diagnosis 1..1CodingPatient's diagnosis
Binding: ICD-10 Codes (example)
.... type 0..1CodingType of Diagnosis
Binding: Example Diagnosis Type Codes (example)
.... drg 0..1CodingDiagnosis Related Group
Binding: Example Diagnosis Related Group Codes (example)
... procedure 0..*BackboneElementProcedures performed
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntProcedure sequence for reference
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Coding, Reference(Procedure)Patient's list of procedures performed
Binding: ICD-10 Procedure Codes (example)
... patient[x] 1..1Identifier, Reference(Patient)The subject of the Products and Services
... coverage 0..*BackboneElementInsurance or medical plan
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance identifier
.... focal 1..1booleanIs the focal Coverage
.... coverage[x] 1..1Identifier, Reference(Coverage)Insurance information
.... businessArrangement 0..1stringBusiness agreement
.... preAuthRef 0..*stringPre-Authorization/Determination Reference
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
.... originalRuleset 0..1CodingOriginal version
Binding: Ruleset Codes (example)
... accident 0..1BackboneElement
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... date 1..1dateWhen the accident occurred see information codes see information codes
.... type 0..1CodingThe nature of the accident
Binding: ActIncidentCode (required)
.... location[x] 0..1Address, Reference(Location)Accident Place
... employmentImpacted 0..1PeriodPeriod unable to work
... hospitalization 0..1PeriodPeriod in hospital
... item S0..*BackboneElementGoods and Services
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance
.... careTeam 0..*BackboneElement
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
..... provider[x] 1..1Reference(Profile qicore-practitioner | Profile qicore-organization)Provider individual or organization
..... responsible 0..1booleanBilling provider
..... role 0..1CodingRole on the team
Binding: Claim Care Team Role Codes (example)
..... qualification 0..1CodingType, classification or Specialization
Binding: Example Provider Qualification Codes (example)
.... diagnosisLinkId 0..*positiveIntApplicable diagnoses
.... revenue 0..1CodingRevenue or cost center code
Binding: Example Revenue Center Codes (example)
.... category 0..1CodingType of service or product
Binding: Benefit SubCategory Codes (example)
.... service S0..1CodingBilling Code
Binding: USCLS Codes (example)
.... modifier 0..*CodingService/Product billing modifiers
Binding: Modifier type Codes (example)
.... programCode 0..*CodingProgram specific reason for item inclusion
Binding: Example Program Reason Codes (example)
.... serviced[x] S0..1date, PeriodDate or dates of Service
.... locationReference 0..1Reference(Profile qicore-location)Place of service
Binding: Example Service Place Codes (example)
.... quantity 0..1SimpleQuantityCount of Products or Services
.... unitPrice 0..1MoneyFee, charge or cost per point
.... factor 0..1decimalPrice scaling factor
.... points 0..1decimalDifficulty scaling factor
.... net 0..1MoneyTotal item cost
.... udi 0..*Reference(Profile qicore-device)Unique Device Identifier
.... bodySite 0..1CodingService Location
Binding: Oral Site Codes (example)
.... subSite 0..*CodingService Sub-location
Binding: Surface Codes (example)
.... detail 0..*BackboneElementAdditional items
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
..... sequence 1..1positiveIntService instance
..... revenue 0..1CodingRevenue or cost center code
Binding: Example Revenue Center Codes (example)
..... category 0..1CodingType of service or product
Binding: Benefit SubCategory Codes (example)
..... service 0..1CodingBilling Code
Binding: USCLS Codes (example)
..... modifier 0..*CodingService/Product billing modifiers
Binding: Modifier type Codes (example)
..... programCode 0..*CodingProgram specific reason for item inclusion
Binding: Example Program Reason Codes (example)
..... quantity 0..1SimpleQuantityCount of Products or Services
..... unitPrice 0..1MoneyFee, charge or cost per point
..... factor 0..1decimalPrice scaling factor
..... points 0..1decimalDifficulty scaling factor
..... net 0..1MoneyTotal additional item cost
..... udi 0..*Reference(Profile qicore-device)Unique Device Identifier
..... subDetail 0..*BackboneElementAdditional items
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
...... sequence 1..1positiveIntService instance
...... revenue 0..1CodingRevenue or cost center code
Binding: Example Revenue Center Codes (example)
...... category 0..1CodingType of service or product
Binding: Benefit SubCategory Codes (example)
...... service 0..1CodingBilling Code
Binding: USCLS Codes (example)
...... modifier 0..*CodingService/Product billing modifiers
Binding: Modifier type Codes (example)
...... programCode 0..*CodingProgram specific reason for item inclusion
Binding: Example Program Reason Codes (example)
...... quantity 0..1SimpleQuantityCount of Products or Services
...... unitPrice 0..1MoneyFee, charge or cost per point
...... factor 0..1decimalPrice scaling factor
...... points 0..1decimalDifficulty scaling factor
...... net 0..1MoneyNet additional item cost
...... udi 0..*Reference(Profile qicore-device)Unique Device Identifier
.... prosthesis 0..1BackboneElementProsthetic details
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
..... initial 0..1booleanIs this the initial service
..... priorDate 0..1dateInitial service Date
..... priorMaterial 0..1CodingProsthetic Material
Binding: Oral Prostho Material type Codes (example)
... total 0..1MoneyTotal claim cost
... missingTeeth 0..*BackboneElementOnly if type = oral
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!∑0..*ExtensionExtensions that cannot be ignored
.... tooth 1..1CodingTooth Code
Binding: Teeth Codes (example)
.... reason 0..1CodingIndicates whether it was extracted or other reason
Binding: Missing Tooth Reason Codes (example)
.... extractionDate 0..1dateDate tooth was extracted if known

doco Documentation for this format

XML Template

yet to be done: Xml template

JSON Template

yet to be done: Json template

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathNameConformanceValueSet
Claim.languageCommon LanguagesextensibleCommon Languages
Claim.statusClaimStatusrequiredClaimStatus
Claim.typeExample Claim Type CodesrequiredExample Claim Type Codes
Claim.subTypeExample Claim SubType CodesexampleExample Claim SubType Codes
Claim.rulesetRuleset CodesexampleRuleset Codes
Claim.originalRulesetRuleset CodesexampleRuleset Codes
Claim.useUserequiredUse
Claim.priorityPriority CodesexamplePriority Codes
Claim.fundsReserveFunds Reservation CodesexampleFunds Reservation Codes
Claim.related.relationshipExample Related Claim Relationship CodesexampleExample Related Claim Relationship Codes
Claim.payee.typePayee Type CodesexamplePayee Type Codes
Claim.payee.resourceTypePayeeResourceTypeexamplePayeeResourceType
Claim.information.categoryClaim Information Category CodesexampleClaim Information Category Codes
Claim.information.codeException CodesexampleException Codes
Claim.diagnosis.diagnosisICD-10 CodesexampleICD-10 Codes
Claim.diagnosis.typeExample Diagnosis Type CodesexampleExample Diagnosis Type Codes
Claim.diagnosis.drgExample Diagnosis Related Group CodesexampleExample Diagnosis Related Group Codes
Claim.procedure.procedure[x]ICD-10 Procedure CodesexampleICD-10 Procedure Codes
Claim.coverage.originalRulesetRuleset CodesexampleRuleset Codes
Claim.accident.typeActIncidentCoderequiredActIncidentCode
Claim.item.careTeam.roleClaim Care Team Role CodesexampleClaim Care Team Role Codes
Claim.item.careTeam.qualificationExample Provider Qualification CodesexampleExample Provider Qualification Codes
Claim.item.revenueExample Revenue Center CodesexampleExample Revenue Center Codes
Claim.item.categoryBenefit SubCategory CodesexampleBenefit SubCategory Codes
Claim.item.serviceUSCLS CodesexampleUSCLS Codes
Claim.item.modifierModifier type CodesexampleModifier type Codes
Claim.item.programCodeExample Program Reason CodesexampleExample Program Reason Codes
Claim.item.locationReferenceExample Service Place CodesexampleExample Service Place Codes
Claim.item.bodySiteOral Site CodesexampleOral Site Codes
Claim.item.subSiteSurface CodesexampleSurface Codes
Claim.item.detail.revenueExample Revenue Center CodesexampleExample Revenue Center Codes
Claim.item.detail.categoryBenefit SubCategory CodesexampleBenefit SubCategory Codes
Claim.item.detail.serviceUSCLS CodesexampleUSCLS Codes
Claim.item.detail.modifierModifier type CodesexampleModifier type Codes
Claim.item.detail.programCodeExample Program Reason CodesexampleExample Program Reason Codes
Claim.item.detail.subDetail.revenueExample Revenue Center CodesexampleExample Revenue Center Codes
Claim.item.detail.subDetail.categoryBenefit SubCategory CodesexampleBenefit SubCategory Codes
Claim.item.detail.subDetail.serviceUSCLS CodesexampleUSCLS Codes
Claim.item.detail.subDetail.modifierModifier type CodesexampleModifier type Codes
Claim.item.detail.subDetail.programCodeExample Program Reason CodesexampleExample Program Reason Codes
Claim.item.prosthesis.priorMaterialOral Prostho Material type CodesexampleOral Prostho Material type Codes
Claim.missingTeeth.toothTeeth CodesexampleTeeth Codes
Claim.missingTeeth.reasonMissing Tooth Reason CodesexampleMissing Tooth Reason Codes

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2ClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
XPath: not(parent::f:contained and f:contained)
dom-1ClaimIf the resource is contained in another resource, it SHALL NOT contain any narrative
XPath: not(parent::f:contained and f:text)
dom-4ClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
XPath: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
dom-3ClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
XPath: not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))
.