This page is part of the Quality Improvement Core Framework (v3.2.0: STU 3) 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
Simple Vision Claim |
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 Wed Aug 22 00:00:00 AEST 2018 as a draft by Health Level Seven, Inc. - CQI WG.
Description of Profiles, Differentials, and Snapshots.
Summary
Mandatory: 7 elements (4 nested mandatory elements)
Must-Support: 15 elements
Structures
This structure refers to these other structures:
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | I | 0..* | Claim, Pre-determination or Pre-authorization | |
id | Σ | 0..1 | id | Logical id of this artifact |
meta | Σ | 0..1 | Meta | Metadata about the resource |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
language | 0..1 | code | Language of the resource content Binding: Common Languages (extensible) Max Binding: All Languages | |
text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
contained | 0..* | Resource | Contained, inline Resources | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier | 0..* | Identifier | Claim number | |
status | ?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required) |
type | 0..1 | CodeableConcept | Type or discipline Binding: Example Claim Type Codes (required) | |
subType | 0..* | CodeableConcept | Finer grained claim type information Binding: Example Claim SubType Codes (example) | |
use | 0..1 | code | complete | proposed | exploratory | other Binding: Use (required) | |
patient | S | 1..1 | Reference(QICore-Patient) | The subject of the Products and Services |
billablePeriod | 0..1 | Period | Period for charge submission | |
created | S | 1..1 | dateTime | Creation date |
enterer | 0..1 | Reference(Practitioner) | Author | |
insurer | 0..1 | Reference(Organization) | Target | |
provider | S | 1..1 | Reference(QICore-Practitioner) | Responsible provider |
organization | 0..1 | Reference(Organization) | Responsible organization | |
priority | 0..1 | CodeableConcept | Desired processing priority Binding: Process Priority Codes (example) | |
fundsReserve | 0..1 | CodeableConcept | Funds requested to be reserved Binding: Funds Reservation Codes (example) | |
related | I | 0..* | BackboneElement | Related Claims which may be revelant to processing this claimn |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
claim | 0..1 | Reference(Claim) | Reference to the related claim | |
relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: Example Related Claim Relationship Codes (example) | |
reference | 0..1 | Identifier | Related file or case reference | |
prescription | S | 1..1 | Reference(QICore-MedicationRequest | VisionPrescription) | Prescription authorizing services or products |
originalPrescription | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | |
payee | I | 0..1 | BackboneElement | Party to be paid any benefits payable |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
type | 1..1 | CodeableConcept | Type of party: Subscriber, Provider, other Binding: Claim Payee Type Codes (example) | |
resourceType | 0..1 | Coding | organization | patient | practitioner | relatedperson Binding: ClaimPayeeResourceType (example) | |
party | 0..1 | Reference(QICore-Practitioner | QICore-Organization | QICore-Patient | QICore-RelatedPerson) | Party to receive the payable | |
referral | 0..1 | Reference(QICore-ReferralRequest) | Treatment Referral | |
facility | 0..1 | Reference(Location) | Servicing Facility | |
careTeam | I | 0..* | BackboneElement | Members of the care team |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Number to covey order of careTeam | |
provider | 1..1 | Reference(QICore-Practitioner | QICore-Organization) | Provider individual or organization | |
responsible | 0..1 | boolean | Billing provider | |
role | 0..1 | CodeableConcept | Role on the team Binding: Claim Care Team Role Codes (example) | |
qualification | 0..1 | CodeableConcept | Type, classification or Specialization Binding: Example Provider Qualification Codes (example) | |
information | I | 0..* | BackboneElement | Exceptions, special considerations, the condition, situation, prior or concurrent issues |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | S | 1..1 | CodeableConcept | General class of information Binding: Claim Information Category Codes (example) |
code | S | 0..1 | CodeableConcept | Type of information Binding: Exception Codes (example) |
timing[x] | 0..1 | date, Period | When it occurred | |
value[x] | 0..1 | string, Quantity, Attachment, Reference(Resource) | Additional Data or supporting information | |
reason | 0..1 | CodeableConcept | Reason associated with the information Binding: Missing Tooth Reason Codes (example) | |
diagnosis | I | 0..* | BackboneElement | List of Diagnosis |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Number to covey order of diagnosis | |
diagnosis[x] | 1..1 | CodeableConcept, Reference(Condition) | Patient's diagnosis Binding: ICD-10 Codes (example) | |
type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Example Diagnosis Type Codes (example) | |
packageCode | 0..1 | CodeableConcept | Package billing code Binding: Example Diagnosis Related Group Codes (example) | |
procedure | SI | 0..* | BackboneElement | Procedures performed |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | S | 1..1 | positiveInt | Procedure sequence for reference |
date | S | 0..1 | dateTime | When the procedure was performed |
procedure[x] | S | 1..1 | CodeableConcept, Reference(Procedure) | Patient's list of procedures performed Binding: ICD-10 Procedure Codes (example) |
insurance | I | 0..* | BackboneElement | Insurance or medical plan |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Service instance identifier | |
focal | 1..1 | boolean | Is the focal Coverage | |
coverage | 1..1 | Reference(Coverage) | Insurance information | |
businessArrangement | 0..1 | string | Business agreement | |
preAuthRef | 0..* | string | Pre-Authorization/Determination Reference | |
claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |
accident | I | 0..1 | BackboneElement | Details about an accident |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
date | 1..1 | date | When the accident occurred see information codes see information codes | |
type | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (required) | |
location[x] | 0..1 | Address, Reference(Location) | Accident Place | |
employmentImpacted | 0..1 | Period | Period unable to work | |
hospitalization | S | 0..1 | Period | Period in hospital |
item | SI | 1..* | BackboneElement | Goods and Services |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Service instance | |
careTeamLinkId | 0..* | positiveInt | Applicable careTeam members | |
diagnosisLinkId | 0..* | positiveInt | Applicable diagnoses | |
procedureLinkId | 0..* | positiveInt | Applicable procedures | |
informationLinkId | 0..* | positiveInt | Applicable exception and supporting information | |
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example) | |
category | 0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example) | |
service | S | 1..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example) |
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example) | |
programCode | 0..* | CodeableConcept | Program specific reason for item inclusion Binding: Example Program Reason Codes (example) | |
serviced[x] | S | 1..1 | date, Period | Date or dates of Service |
locationReference | 0..1 | Reference(QICore-Location) | Place of service | |
quantity | 0..1 | SimpleQuantity | Count of Products or Services | |
unitPrice | 0..1 | Money | Fee, charge or cost per point | |
factor | 0..1 | decimal | Price scaling factor | |
net | 0..1 | Money | Total item cost | |
udi | 0..* | Reference(QICore-Device) | Unique Device Identifier | |
bodySite | 0..1 | CodeableConcept | Service Location Binding: Oral Site Codes (example) | |
subSite | 0..* | CodeableConcept | Service Sub-location Binding: Surface Codes (example) | |
encounter | S | 0..* | Reference(QICore-Encounter) | Encounters related to this billed item |
detail | I | 0..* | BackboneElement | Additional items |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Service instance | |
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example) | |
category | 0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example) | |
service | 0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example) | |
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example) | |
programCode | 0..* | CodeableConcept | Program specific reason for item inclusion Binding: Example Program Reason Codes (example) | |
quantity | 0..1 | SimpleQuantity | Count of Products or Services | |
unitPrice | 0..1 | Money | Fee, charge or cost per point | |
factor | 0..1 | decimal | Price scaling factor | |
net | 0..1 | Money | Total additional item cost | |
udi | 0..* | Reference(QICore-Device) | Unique Device Identifier | |
subDetail | I | 0..* | BackboneElement | Additional items |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Service instance | |
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example) | |
category | 0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example) | |
service | 0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example) | |
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example) | |
programCode | 0..* | CodeableConcept | Program specific reason for item inclusion Binding: Example Program Reason Codes (example) | |
quantity | 0..1 | SimpleQuantity | Count of Products or Services | |
unitPrice | 0..1 | Money | Fee, charge or cost per point | |
factor | 0..1 | decimal | Price scaling factor | |
net | 0..1 | Money | Net additional item cost | |
udi | 0..1 | Reference(QICore-Device) | Unique Device Identifier | |
total | 0..1 | Money | Total claim cost | |
Documentation for this format |
Summary
Mandatory: 7 elements (4 nested mandatory elements)
Must-Support: 15 elements
Structures
This structure refers to these other structures:
Differential View
Snapshot View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | I | 0..* | Claim, Pre-determination or Pre-authorization | |
id | Σ | 0..1 | id | Logical id of this artifact |
meta | Σ | 0..1 | Meta | Metadata about the resource |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
language | 0..1 | code | Language of the resource content Binding: Common Languages (extensible) Max Binding: All Languages | |
text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
contained | 0..* | Resource | Contained, inline Resources | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier | 0..* | Identifier | Claim number | |
status | ?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required) |
type | 0..1 | CodeableConcept | Type or discipline Binding: Example Claim Type Codes (required) | |
subType | 0..* | CodeableConcept | Finer grained claim type information Binding: Example Claim SubType Codes (example) | |
use | 0..1 | code | complete | proposed | exploratory | other Binding: Use (required) | |
patient | S | 1..1 | Reference(QICore-Patient) | The subject of the Products and Services |
billablePeriod | 0..1 | Period | Period for charge submission | |
created | S | 1..1 | dateTime | Creation date |
enterer | 0..1 | Reference(Practitioner) | Author | |
insurer | 0..1 | Reference(Organization) | Target | |
provider | S | 1..1 | Reference(QICore-Practitioner) | Responsible provider |
organization | 0..1 | Reference(Organization) | Responsible organization | |
priority | 0..1 | CodeableConcept | Desired processing priority Binding: Process Priority Codes (example) | |
fundsReserve | 0..1 | CodeableConcept | Funds requested to be reserved Binding: Funds Reservation Codes (example) | |
related | I | 0..* | BackboneElement | Related Claims which may be revelant to processing this claimn |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
claim | 0..1 | Reference(Claim) | Reference to the related claim | |
relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: Example Related Claim Relationship Codes (example) | |
reference | 0..1 | Identifier | Related file or case reference | |
prescription | S | 1..1 | Reference(QICore-MedicationRequest | VisionPrescription) | Prescription authorizing services or products |
originalPrescription | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | |
payee | I | 0..1 | BackboneElement | Party to be paid any benefits payable |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
type | 1..1 | CodeableConcept | Type of party: Subscriber, Provider, other Binding: Claim Payee Type Codes (example) | |
resourceType | 0..1 | Coding | organization | patient | practitioner | relatedperson Binding: ClaimPayeeResourceType (example) | |
party | 0..1 | Reference(QICore-Practitioner | QICore-Organization | QICore-Patient | QICore-RelatedPerson) | Party to receive the payable | |
referral | 0..1 | Reference(QICore-ReferralRequest) | Treatment Referral | |
facility | 0..1 | Reference(Location) | Servicing Facility | |
careTeam | I | 0..* | BackboneElement | Members of the care team |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Number to covey order of careTeam | |
provider | 1..1 | Reference(QICore-Practitioner | QICore-Organization) | Provider individual or organization | |
responsible | 0..1 | boolean | Billing provider | |
role | 0..1 | CodeableConcept | Role on the team Binding: Claim Care Team Role Codes (example) | |
qualification | 0..1 | CodeableConcept | Type, classification or Specialization Binding: Example Provider Qualification Codes (example) | |
information | I | 0..* | BackboneElement | Exceptions, special considerations, the condition, situation, prior or concurrent issues |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | S | 1..1 | CodeableConcept | General class of information Binding: Claim Information Category Codes (example) |
code | S | 0..1 | CodeableConcept | Type of information Binding: Exception Codes (example) |
timing[x] | 0..1 | date, Period | When it occurred | |
value[x] | 0..1 | string, Quantity, Attachment, Reference(Resource) | Additional Data or supporting information | |
reason | 0..1 | CodeableConcept | Reason associated with the information Binding: Missing Tooth Reason Codes (example) | |
diagnosis | I | 0..* | BackboneElement | List of Diagnosis |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Number to covey order of diagnosis | |
diagnosis[x] | 1..1 | CodeableConcept, Reference(Condition) | Patient's diagnosis Binding: ICD-10 Codes (example) | |
type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Example Diagnosis Type Codes (example) | |
packageCode | 0..1 | CodeableConcept | Package billing code Binding: Example Diagnosis Related Group Codes (example) | |
procedure | SI | 0..* | BackboneElement | Procedures performed |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | S | 1..1 | positiveInt | Procedure sequence for reference |
date | S | 0..1 | dateTime | When the procedure was performed |
procedure[x] | S | 1..1 | CodeableConcept, Reference(Procedure) | Patient's list of procedures performed Binding: ICD-10 Procedure Codes (example) |
insurance | I | 0..* | BackboneElement | Insurance or medical plan |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Service instance identifier | |
focal | 1..1 | boolean | Is the focal Coverage | |
coverage | 1..1 | Reference(Coverage) | Insurance information | |
businessArrangement | 0..1 | string | Business agreement | |
preAuthRef | 0..* | string | Pre-Authorization/Determination Reference | |
claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |
accident | I | 0..1 | BackboneElement | Details about an accident |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
date | 1..1 | date | When the accident occurred see information codes see information codes | |
type | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (required) | |
location[x] | 0..1 | Address, Reference(Location) | Accident Place | |
employmentImpacted | 0..1 | Period | Period unable to work | |
hospitalization | S | 0..1 | Period | Period in hospital |
item | SI | 1..* | BackboneElement | Goods and Services |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Service instance | |
careTeamLinkId | 0..* | positiveInt | Applicable careTeam members | |
diagnosisLinkId | 0..* | positiveInt | Applicable diagnoses | |
procedureLinkId | 0..* | positiveInt | Applicable procedures | |
informationLinkId | 0..* | positiveInt | Applicable exception and supporting information | |
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example) | |
category | 0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example) | |
service | S | 1..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example) |
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example) | |
programCode | 0..* | CodeableConcept | Program specific reason for item inclusion Binding: Example Program Reason Codes (example) | |
serviced[x] | S | 1..1 | date, Period | Date or dates of Service |
locationReference | 0..1 | Reference(QICore-Location) | Place of service | |
quantity | 0..1 | SimpleQuantity | Count of Products or Services | |
unitPrice | 0..1 | Money | Fee, charge or cost per point | |
factor | 0..1 | decimal | Price scaling factor | |
net | 0..1 | Money | Total item cost | |
udi | 0..* | Reference(QICore-Device) | Unique Device Identifier | |
bodySite | 0..1 | CodeableConcept | Service Location Binding: Oral Site Codes (example) | |
subSite | 0..* | CodeableConcept | Service Sub-location Binding: Surface Codes (example) | |
encounter | S | 0..* | Reference(QICore-Encounter) | Encounters related to this billed item |
detail | I | 0..* | BackboneElement | Additional items |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Service instance | |
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example) | |
category | 0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example) | |
service | 0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example) | |
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example) | |
programCode | 0..* | CodeableConcept | Program specific reason for item inclusion Binding: Example Program Reason Codes (example) | |
quantity | 0..1 | SimpleQuantity | Count of Products or Services | |
unitPrice | 0..1 | Money | Fee, charge or cost per point | |
factor | 0..1 | decimal | Price scaling factor | |
net | 0..1 | Money | Total additional item cost | |
udi | 0..* | Reference(QICore-Device) | Unique Device Identifier | |
subDetail | I | 0..* | BackboneElement | Additional items |
id | 0..1 | string | xml:id (or equivalent in JSON) | |
extension | 0..* | Extension | Additional Content defined by implementations | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
sequence | 1..1 | positiveInt | Service instance | |
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example) | |
category | 0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example) | |
service | 0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example) | |
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example) | |
programCode | 0..* | CodeableConcept | Program specific reason for item inclusion Binding: Example Program Reason Codes (example) | |
quantity | 0..1 | SimpleQuantity | Count of Products or Services | |
unitPrice | 0..1 | Money | Fee, charge or cost per point | |
factor | 0..1 | decimal | Price scaling factor | |
net | 0..1 | Money | Net additional item cost | |
udi | 0..1 | Reference(QICore-Device) | Unique Device Identifier | |
total | 0..1 | Money | Total claim cost | |
Documentation for this format |
Path | Conformance | ValueSet |
Claim.information.category | example | Claim Information Category Codes |
Claim.information.code | example | Exception Codes |
Claim.procedure.procedure[x] | example | ICD-10 Procedure Codes |
Claim.item.service | example | USCLS Codes |
Id | Path | Details | Requirements |
dom-2 | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-1 | Claim | If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty() | |
dom-4 | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-3 | Claim | If 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-1 | Claim.related | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.payee | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.careTeam | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.information | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.diagnosis | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.procedure | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.insurance | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.accident | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.item | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.item.detail | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) | |
ele-1 | Claim.item.detail.subDetail | All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count()) |