abstractbaseDefinitioncopyrightdatedescriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisherpurposestatustitletypeurlversion| Left: | QICoreClaim (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim) |
| Right: | QICoreClaim (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim) |
| Error | Claim.patient | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient]]) |
| Error | Claim.provider | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization]]) |
| Error | Claim.prescription | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-devicerequest], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest], CanonicalType[http://hl7.org/fhir/StructureDefinition/VisionPrescription]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-devicerequest], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest], CanonicalType[http://hl7.org/fhir/StructureDefinition/VisionPrescription]]) |
| Error | Claim.payee.party | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson]]) |
| Error | Claim.referral | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest]]) |
| Error | Claim.facility | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location]]) |
| Error | Claim.careTeam.provider | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole], CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization]]) |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/Claim | ||
| copyright | |||
| date | 2018-08-22 | ||
| description | Profile of Claim for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors. | ||
| experimental | false | ||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | QICoreClaim | ||
| publisher | http://www.hl7.org/Special/committees/cqi/index.cfm | ||
| purpose | |||
| status | active | ||
| title | |||
| type | Claim | ||
| url | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim | ||
| version | 5.0.0-ballot | ||
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | L Type | L Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||||||||
 id | Σ | 0..1 | string | Logical id of this artifact | Σ | 0..1 | string | 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: todo (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: CommonLanguages (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 | |||||||||||
 extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
| identifier | 0..* | Identifier | Business Identifier for claim | 0..* | Identifier | Business Identifier for claim | |||||||||||
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: todo (required): A code specifying the state of the resource instance. | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | |||||||||
| type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: todo (extensible): The type or discipline-style of the claim. | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | |||||||||
| subType | 0..1 | CodeableConcept | More granular claim type Binding: todo (example): A more granular claim typecode. | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |||||||||||
| use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: todo (required): The purpose of the Claim: predetermination, preauthorization, claim. | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. | |||||||||
| patient | SΣ | 1..1 | Reference(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient) | The recipient of the products and services | SΣ | 1..1 | Reference(QICorePatient) | The recipient of the products and services |
| ||||||||
| billablePeriod | SΣ | 0..1 | Period | Relevant time frame for the claim | SΣ | 0..1 | Period | Relevant time frame for the claim | |||||||||
| created | SΣ | 1..1 | dateTime | Resource creation date | SΣ | 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 | 0..1 | Reference(Organization) | Target | Σ | 0..1 | Reference(Organization) | Target | |||||||||
| provider | SΣ | 1..1 | Reference(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization) | Party responsible for the claim | SΣ | 1..1 | Reference(QICore Practitioner | QICorePractitionerRole | QICoreOrganization) | Party responsible for the claim |
| ||||||||
| priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: todo (example): The timeliness with which processing is required: stat, normal, deferred. | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | |||||||||
| fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: todo (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
 related | 0..* | BackboneElement | Prior or corollary claims | 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: todo (example): Relationship of this claim to a related Claim. | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||||||||
| reference | 0..1 | Identifier | File or case reference | 0..1 | Identifier | File or case reference | |||||||||||
| prescription | S | 0..1 | Reference(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-devicerequest | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest | VisionPrescription) | Prescription authorizing services and products | S | 0..1 | Reference(QICoreDeviceRequest | QICore 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 | 0..1 | BackboneElement | Recipient of benefits payable | 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: todo (example): A code for the party to be reimbursed. | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||||||||
| party | 0..1 | Reference(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson) | Recipient reference | 0..1 | Reference(QICore Practitioner | QICorePractitionerRole | QICoreOrganization | QICorePatient | QICoreRelatedPerson) | Recipient reference |
| ||||||||||
| referral | 0..1 | Reference(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest) | Treatment referral | 0..1 | Reference(QICore Service Request) | Treatment referral |
| ||||||||||
| facility | 0..1 | Reference(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location) | Servicing facility | 0..1 | Reference(QICoreLocation) | Servicing facility |
| ||||||||||
| careTeam | 0..* | BackboneElement | Members of the care team | 0..* | BackboneElement | Members of the care team | |||||||||||
| 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(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization) | Practitioner or organization | 1..1 | Reference(QICore Practitioner | QICorePractitionerRole | QICoreOrganization) | Practitioner or organization |
| ||||||||||
| responsible | 0..1 | boolean | Indicator of the lead practitioner | 0..1 | boolean | Indicator of the lead practitioner | |||||||||||
| role | 0..1 | CodeableConcept | Function within the team Binding: todo (example): The role codes for the care team members. | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. | |||||||||||
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: todo (example): Provider professional qualifications. | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |||||||||||
| supportingInfo | 0..* | BackboneElement | Supporting information | 0..* | BackboneElement | Supporting 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 | Information instance identifier | 1..1 | positiveInt | Information instance identifier | |||||||||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: todo (example): The valuset used for additional information category codes. | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |||||||||||
| code | 0..1 | CodeableConcept | Type of information Binding: todo (example): The valuset used for additional information codes. | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (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: todo (example): Reason codes for the missing teeth. | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||||||||
| diagnosis | 0..* | BackboneElement | Pertinent diagnosis information | 0..* | BackboneElement | Pertinent diagnosis 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 | Diagnosis instance identifier | 1..1 | positiveInt | Diagnosis instance identifier | |||||||||||
| diagnosis[x] | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: todo (example): Example ICD10 Diagnostic codes. | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | |||||||||||
| type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: todo (example): The type of the diagnosis: admitting, principal, discharge. | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. | |||||||||||
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: todo (example): Present on admission. | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||||||||
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: todo (example): The DRG codes associated with the diagnosis. | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||||||||
| procedure | 0..* | BackboneElement | Clinical procedures performed | 0..* | BackboneElement | Clinical procedures performed | |||||||||||
| 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 | Procedure instance identifier | 1..1 | positiveInt | Procedure instance identifier | |||||||||||
| type | 0..* | CodeableConcept | Category of Procedure Binding: todo (example): Example procedure type codes. | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||||||||
| 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: todo (example): Example ICD10 Procedure codes. | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ICD-10ProcedureCodes (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(Coverage) | Insurance information | Σ | 1..1 | Reference(Coverage) | Insurance information | |||||||||
| businessArrangement | 0..1 | string | Additional provider contract number | 0..1 | string | Additional provider contract number | |||||||||||
| preAuthRef | 0..* | string | Prior authorization reference number | 0..* | 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: todo (extensible): Type of accident: work place, auto, etc. | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |||||||||||
| location[x] | 0..1 | Address, Reference(Location) | Where the event occurred | 0..1 | Address, Reference(Location) | Where the event occurred | |||||||||||
| item | 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 | |||||||||||
| careTeamSequence | 0..* | positiveInt | Applicable careTeam members | 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: todo (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: todo (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: todo (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: todo (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 | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: todo (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||||||||
| serviced[x] | 0..1 | date, Period | Date or dates of service or product delivery | 0..1 | date, Period | Date or dates of service or product delivery | |||||||||||
| location[x] | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: todo (example): Place of service: pharmacy, school, prison, etc. | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | |||||||||||
| quantity | 0..1 | Quantity | Count of products or services | 0..1 | SimpleQuantity | 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 | |||||||||||
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: todo (example): The code for the teeth, quadrant, sextant and arch. | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||||||||
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: todo (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||||||||
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||||||||
 detail | 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: todo (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: todo (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: todo (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: todo (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: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: todo (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||||||||
| quantity | 0..1 | Quantity | Count of products or services | 0..1 | SimpleQuantity | 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: todo (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: todo (example): Benefit categories such as: oral-basic, major, glasses. | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: todo (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: todo (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: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: todo (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||||||||
| quantity | 0..1 | Quantity | Count of products or services | 0..1 | SimpleQuantity | 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 | 0..1 | Money | Total claim cost | 0..1 | Money | Total claim cost | |||||||||||
| Documentation for this format | |||||||||||||||||