Qi-Core Implementation Guide (Release 2.1 Trial-Use Ballot)

This page is part of the Quality Improvement Core Framework (v2.1.0: STU 3 Ballot 1) based on FHIR R3. 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

Examples:

Simple Vision Claim

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is: 

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

Profile of Claim for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

This profile builds on Claim.

This profile was published on Mon Aug 21 00:00:00 AEST 2017 as a draft by Health Level Seven International (Clinical Quality Information - QICore).

Description of Profiles, Differentials, and Snapshots.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim I0..*Claim, Pre-determination or Pre-authorization
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..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 ?!Σ0..1codeactive | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required)
... type 0..1CodeableConceptType or discipline
Binding: Example Claim Type Codes (required)
... subType 0..*CodeableConceptFiner grained claim type information
Binding: Example Claim SubType Codes (example)
... use 0..1codecomplete | proposed | exploratory | other
Binding: Use (required)
... patient S1..1Reference(QICore-Patient)The subject of the Products and Services
... billablePeriod 0..1PeriodPeriod for charge submission
... created S1..1dateTimeCreation date
... enterer 0..1Reference(Practitioner)Author
... insurer 0..1Reference(Organization)Target
... provider S1..1Reference(QICore-Practitioner)Responsible provider
... organization 0..1Reference(Organization)Responsible organization
... priority 0..1CodeableConceptDesired processing priority
Binding: Process Priority Codes (example)
... fundsReserve 0..1CodeableConceptFunds requested to be reserved
Binding: Funds Reservation Codes (example)
... related I0..*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 ?!Σ0..*ExtensionExtensions that cannot be ignored
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: Example Related Claim Relationship Codes (example)
.... reference 0..1IdentifierRelated file or case reference
... prescription S1..1Reference(QICore-MedicationRequest), Reference(VisionPrescription)Prescription authorizing services or products
... originalPrescription 0..1Reference(MedicationRequest)Original prescription if superceded by fulfiller
... payee I0..1BackboneElementParty to be paid any benefits payable
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type 1..1CodeableConceptType of party: Subscriber, Provider, other
Binding: Claim Payee Type Codes (example)
.... resourceType 0..1Codingorganization | patient | practitioner | relatedperson
Binding: ClaimPayeeResourceType (example)
.... party 0..1Reference(QICore-Practitioner), Reference(QICore-Organization), Reference(QICore-Patient), Reference(QICore-RelatedPerson)Party to receive the payable
... referral 0..1Reference(QICore-ReferralRequest)Treatment Referral
... facility 0..1Reference(Location)Servicing Facility
... careTeam I0..*BackboneElementMembers of the care team
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of careTeam
.... provider 1..1Reference(QICore-Practitioner), Reference(QICore-Organization)Provider individual or organization
.... responsible 0..1booleanBilling provider
.... role 0..1CodeableConceptRole on the team
Binding: Claim Care Team Role Codes (example)
.... qualification 0..1CodeableConceptType, classification or Specialization
Binding: Example Provider Qualification Codes (example)
... information I0..*BackboneElementExceptions, special considerations, the condition, situation, prior or concurrent issues
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntInformation instance identifier
.... category S1..1CodeableConceptGeneral class of information
Binding: Claim Information Category Codes (example)
.... code S0..1CodeableConceptType of information
Binding: Exception Codes (example)
.... timing[x] 0..1date, PeriodWhen it occurred
.... value[x] 0..1string, Quantity, Attachment, Reference(Resource)Additional Data or supporting information
.... reason 0..1CodeableConceptReason associated with the information
Binding: Missing Tooth Reason Codes (example)
... diagnosis I0..*BackboneElementList of Diagnosis
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of diagnosis
.... diagnosis[x] 1..1CodeableConcept, Reference(Condition)Patient's diagnosis
Binding: ICD-10 Codes (example)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Binding: Example Diagnosis Type Codes (example)
.... packageCode 0..1CodeableConceptPackage billing code
Binding: Example Diagnosis Related Group Codes (example)
... procedure SI0..*BackboneElementProcedures performed
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence S1..1positiveIntProcedure sequence for reference
.... date S0..1dateTimeWhen the procedure was performed
.... procedure[x] S1..1CodeableConcept, Reference(Procedure)Patient's list of procedures performed
Binding: ICD-10 Procedure Codes (example)
... insurance I0..*BackboneElementInsurance or medical plan
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance identifier
.... focal 1..1booleanIs the focal Coverage
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringBusiness agreement
.... preAuthRef 0..*stringPre-Authorization/Determination Reference
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... accident I0..1BackboneElementDetails about an accident
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... date 1..1dateWhen the accident occurred see information codes see information codes
.... type 0..1CodeableConceptThe nature of the accident
Binding: ActIncidentCode (required)
.... location[x] 0..1Address, Reference(Location)Accident Place
... employmentImpacted 0..1PeriodPeriod unable to work
... hospitalization S0..1PeriodPeriod in hospital
... item SI1..*BackboneElementGoods and Services
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance
.... careTeamLinkId 0..*positiveIntApplicable careTeam members
.... diagnosisLinkId 0..*positiveIntApplicable diagnoses
.... procedureLinkId 0..*positiveIntApplicable procedures
.... informationLinkId 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: Example Revenue Center Codes (example)
.... category 0..1CodeableConceptType of service or product
Binding: Benefit SubCategory Codes (example)
.... service S1..1CodeableConceptBilling Code
Binding: USCLS Codes (example)
.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: Modifier type Codes (example)
.... programCode 0..*CodeableConceptProgram specific reason for item inclusion
Binding: Example Program Reason Codes (example)
.... serviced[x] S1..1date, PeriodDate or dates of Service
.... locationReference 0..1Reference(QICore-Location)Place of service
.... quantity 0..1SimpleQuantityCount of Products or Services
.... unitPrice 0..1MoneyFee, charge or cost per point
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... udi 0..*Reference(QICore-Device)Unique Device Identifier
.... bodySite 0..1CodeableConceptService Location
Binding: Oral Site Codes (example)
.... subSite 0..*CodeableConceptService Sub-location
Binding: Surface Codes (example)
.... encounter S0..*Reference(QICore-Encounter)Encounters related to this billed item
.... detail I0..*BackboneElementAdditional items
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... sequence 1..1positiveIntService instance
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: Example Revenue Center Codes (example)
..... category 0..1CodeableConceptType of service or product
Binding: Benefit SubCategory Codes (example)
..... service 0..1CodeableConceptBilling Code
Binding: USCLS Codes (example)
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: Modifier type Codes (example)
..... programCode 0..*CodeableConceptProgram 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
..... net 0..1MoneyTotal additional item cost
..... udi 0..*Reference(QICore-Device)Unique Device Identifier
..... subDetail I0..*BackboneElementAdditional items
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
...... sequence 1..1positiveIntService instance
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: Example Revenue Center Codes (example)
...... category 0..1CodeableConceptType of service or product
Binding: Benefit SubCategory Codes (example)
...... service 0..1CodeableConceptBilling Code
Binding: USCLS Codes (example)
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: Modifier type Codes (example)
...... programCode 0..*CodeableConceptProgram 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
...... net 0..1MoneyNet additional item cost
...... udi 0..1Reference(QICore-Device)Unique Device Identifier
... total 0..1MoneyTotal claim cost

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim I0..*Claim, Pre-determination or Pre-authorization
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..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 ?!Σ0..1codeactive | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes (required)
... type 0..1CodeableConceptType or discipline
Binding: Example Claim Type Codes (required)
... subType 0..*CodeableConceptFiner grained claim type information
Binding: Example Claim SubType Codes (example)
... use 0..1codecomplete | proposed | exploratory | other
Binding: Use (required)
... patient S1..1Reference(QICore-Patient)The subject of the Products and Services
... billablePeriod 0..1PeriodPeriod for charge submission
... created S1..1dateTimeCreation date
... enterer 0..1Reference(Practitioner)Author
... insurer 0..1Reference(Organization)Target
... provider S1..1Reference(QICore-Practitioner)Responsible provider
... organization 0..1Reference(Organization)Responsible organization
... priority 0..1CodeableConceptDesired processing priority
Binding: Process Priority Codes (example)
... fundsReserve 0..1CodeableConceptFunds requested to be reserved
Binding: Funds Reservation Codes (example)
... related I0..*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 ?!Σ0..*ExtensionExtensions that cannot be ignored
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: Example Related Claim Relationship Codes (example)
.... reference 0..1IdentifierRelated file or case reference
... prescription S1..1Reference(QICore-MedicationRequest), Reference(VisionPrescription)Prescription authorizing services or products
... originalPrescription 0..1Reference(MedicationRequest)Original prescription if superceded by fulfiller
... payee I0..1BackboneElementParty to be paid any benefits payable
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type 1..1CodeableConceptType of party: Subscriber, Provider, other
Binding: Claim Payee Type Codes (example)
.... resourceType 0..1Codingorganization | patient | practitioner | relatedperson
Binding: ClaimPayeeResourceType (example)
.... party 0..1Reference(QICore-Practitioner), Reference(QICore-Organization), Reference(QICore-Patient), Reference(QICore-RelatedPerson)Party to receive the payable
... referral 0..1Reference(QICore-ReferralRequest)Treatment Referral
... facility 0..1Reference(Location)Servicing Facility
... careTeam I0..*BackboneElementMembers of the care team
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of careTeam
.... provider 1..1Reference(QICore-Practitioner), Reference(QICore-Organization)Provider individual or organization
.... responsible 0..1booleanBilling provider
.... role 0..1CodeableConceptRole on the team
Binding: Claim Care Team Role Codes (example)
.... qualification 0..1CodeableConceptType, classification or Specialization
Binding: Example Provider Qualification Codes (example)
... information I0..*BackboneElementExceptions, special considerations, the condition, situation, prior or concurrent issues
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntInformation instance identifier
.... category S1..1CodeableConceptGeneral class of information
Binding: Claim Information Category Codes (example)
.... code S0..1CodeableConceptType of information
Binding: Exception Codes (example)
.... timing[x] 0..1date, PeriodWhen it occurred
.... value[x] 0..1string, Quantity, Attachment, Reference(Resource)Additional Data or supporting information
.... reason 0..1CodeableConceptReason associated with the information
Binding: Missing Tooth Reason Codes (example)
... diagnosis I0..*BackboneElementList of Diagnosis
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of diagnosis
.... diagnosis[x] 1..1CodeableConcept, Reference(Condition)Patient's diagnosis
Binding: ICD-10 Codes (example)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Binding: Example Diagnosis Type Codes (example)
.... packageCode 0..1CodeableConceptPackage billing code
Binding: Example Diagnosis Related Group Codes (example)
... procedure SI0..*BackboneElementProcedures performed
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence S1..1positiveIntProcedure sequence for reference
.... date S0..1dateTimeWhen the procedure was performed
.... procedure[x] S1..1CodeableConcept, Reference(Procedure)Patient's list of procedures performed
Binding: ICD-10 Procedure Codes (example)
... insurance I0..*BackboneElementInsurance or medical plan
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance identifier
.... focal 1..1booleanIs the focal Coverage
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringBusiness agreement
.... preAuthRef 0..*stringPre-Authorization/Determination Reference
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... accident I0..1BackboneElementDetails about an accident
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... date 1..1dateWhen the accident occurred see information codes see information codes
.... type 0..1CodeableConceptThe nature of the accident
Binding: ActIncidentCode (required)
.... location[x] 0..1Address, Reference(Location)Accident Place
... employmentImpacted 0..1PeriodPeriod unable to work
... hospitalization S0..1PeriodPeriod in hospital
... item SI1..*BackboneElementGoods and Services
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance
.... careTeamLinkId 0..*positiveIntApplicable careTeam members
.... diagnosisLinkId 0..*positiveIntApplicable diagnoses
.... procedureLinkId 0..*positiveIntApplicable procedures
.... informationLinkId 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: Example Revenue Center Codes (example)
.... category 0..1CodeableConceptType of service or product
Binding: Benefit SubCategory Codes (example)
.... service S1..1CodeableConceptBilling Code
Binding: USCLS Codes (example)
.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: Modifier type Codes (example)
.... programCode 0..*CodeableConceptProgram specific reason for item inclusion
Binding: Example Program Reason Codes (example)
.... serviced[x] S1..1date, PeriodDate or dates of Service
.... locationReference 0..1Reference(QICore-Location)Place of service
.... quantity 0..1SimpleQuantityCount of Products or Services
.... unitPrice 0..1MoneyFee, charge or cost per point
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... udi 0..*Reference(QICore-Device)Unique Device Identifier
.... bodySite 0..1CodeableConceptService Location
Binding: Oral Site Codes (example)
.... subSite 0..*CodeableConceptService Sub-location
Binding: Surface Codes (example)
.... encounter S0..*Reference(QICore-Encounter)Encounters related to this billed item
.... detail I0..*BackboneElementAdditional items
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... sequence 1..1positiveIntService instance
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: Example Revenue Center Codes (example)
..... category 0..1CodeableConceptType of service or product
Binding: Benefit SubCategory Codes (example)
..... service 0..1CodeableConceptBilling Code
Binding: USCLS Codes (example)
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: Modifier type Codes (example)
..... programCode 0..*CodeableConceptProgram 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
..... net 0..1MoneyTotal additional item cost
..... udi 0..*Reference(QICore-Device)Unique Device Identifier
..... subDetail I0..*BackboneElementAdditional items
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
...... sequence 1..1positiveIntService instance
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: Example Revenue Center Codes (example)
...... category 0..1CodeableConceptType of service or product
Binding: Benefit SubCategory Codes (example)
...... service 0..1CodeableConceptBilling Code
Binding: USCLS Codes (example)
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: Modifier type Codes (example)
...... programCode 0..*CodeableConceptProgram 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
...... net 0..1MoneyNet additional item cost
...... udi 0..1Reference(QICore-Device)Unique Device Identifier
... total 0..1MoneyTotal claim cost

doco Documentation for this format

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathNameConformanceValueSet
Claim.languageCommon LanguagesextensibleCommon Languages
Claim.statusFinancial Resource Status CodesrequiredFinancial Resource Status Codes
Claim.typeExample Claim Type CodesrequiredExample Claim Type Codes
Claim.subTypeExample Claim SubType CodesexampleExample Claim SubType Codes
Claim.useUserequiredUse
Claim.priorityProcess Priority CodesexampleProcess Priority Codes
Claim.fundsReserveFunds Reservation CodesexampleFunds Reservation Codes
Claim.related.relationshipExample Related Claim Relationship CodesexampleExample Related Claim Relationship Codes
Claim.payee.typeClaim Payee Type CodesexampleClaim Payee Type Codes
Claim.payee.resourceTypeClaimPayeeResourceTypeexampleClaimPayeeResourceType
Claim.careTeam.roleClaim Care Team Role CodesexampleClaim Care Team Role Codes
Claim.careTeam.qualificationExample Provider Qualification CodesexampleExample Provider Qualification Codes
Claim.information.categoryClaim Information Category CodesexampleClaim Information Category Codes
Claim.information.codeException CodesexampleException Codes
Claim.information.reasonMissing Tooth Reason CodesexampleMissing Tooth Reason Codes
Claim.diagnosis.diagnosis[x]ICD-10 CodesexampleICD-10 Codes
Claim.diagnosis.typeExample Diagnosis Type CodesexampleExample Diagnosis Type Codes
Claim.diagnosis.packageCodeExample Diagnosis Related Group CodesexampleExample Diagnosis Related Group Codes
Claim.procedure.procedure[x]ICD-10 Procedure CodesexampleICD-10 Procedure Codes
Claim.accident.typeActIncidentCoderequiredActIncidentCode
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.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

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2ClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-1ClaimIf the resource is contained in another resource, it SHALL NOT contain any narrative
: contained.text.empty()
dom-4ClaimIf 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-3ClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
: contained.where(('#'+id in %resource.descendants().reference).not()).empty()
ele-1Claim.relatedAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.payeeAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.careTeamAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.informationAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.diagnosisAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.procedureAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.insuranceAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.accidentAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.itemAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.item.detailAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Claim.item.detail.subDetailAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())