QI-Core Implementation Guide: STU 3.2 (v3.2.0 for FHIR 3.0.1)
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 
Formats: Narrative, XML, JSON, Turtle
Raw xml
<StructureDefinition xmlns="http://hl7.org/fhir"> <id value="qicore-claim"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Minimum and Maximum # of times the the element can appear in the instance">Card.</a></th><th style="width: 100px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Additional information about the element">Description & Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/STU3/help16.png" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim" title="A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.">Claim</a><a name="Claim"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.patient" title="Patient Resource.">patient</a><a name="Claim.patient"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.prescription" title="Prescription to support the dispensing of Pharmacy or Vision products.">prescription</a><a name="Claim.prescription"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest | <a href="http://hl7.org/fhir/STU3/visionprescription.html">VisionPrescription</a>)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.provider" title="The provider which is responsible for the bill, claim pre-determination, pre-authorization.">provider</a><a name="Claim.provider"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.procedure" title="Procedures performed.">procedure</a><a name="Claim.procedure"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.procedure.sequence" title="Procedure sequence for reference.">sequence</a><a name="Claim.procedure.sequence"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#positiveInt">positiveInt</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.procedure.date" title="When the procedure was performed.">date</a><a name="Claim.procedure.date"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#dateTime">dateTime</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.procedure.procedure[x]" title="When the procedure was performed.">procedure[x]</a><a name="Claim.procedure.procedure_x_"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.hospitalization" title="Period in hospital.">hospitalization</a><a name="Claim.hospitalization"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#Period">Period</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.created" title="The date when the enclosed suite of services were performed or completed.">created</a><a name="Claim.created"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#dateTime">dateTime</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.referral" title="The referral resource which lists the date, practitioner, reason and other supporting information.">referral</a><a name="Claim.referral"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-referralrequest)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.diagnosis" title="List of patient diagnosis for which care is sought.">diagnosis</a><a name="Claim.diagnosis"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.diagnosis.type" title="The type of the Diagnosis, for example: admitting, primary, secondary, discharge.">type</a><a name="Claim.diagnosis.type"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="font-weight:bold">Binding: </span><a href="http://hl7.org/fhir/STU3/valueset-ex-diagnosistype.html">Example Diagnosis Type Codes</a> (<a href="http://hl7.org/fhir/STU3/terminologies.html#example" title="Instances are not expected or even encouraged to draw from the specified value set. The value set merely provides examples of the types of concepts intended to be included.">example</a>)<br/></td></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.payee" title="The party to be reimbursed for the services.">payee</a><a name="Claim.payee"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.payee.party" title="Party to be reimbursed: Subscriber, provider, other.">party</a><a name="Claim.payee.party"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner | 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)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.careTeam" title="The members of the team who provided the overall service as well as their role and whether responsible and qualifications.">careTeam</a><a name="Claim.careTeam"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.careTeam.provider" title="Member of the team who provided the overall service.">provider</a><a name="Claim.careTeam.provider"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item" title="First tier of goods and services.">item</a><a name="Claim.item"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item.encounter" title="Encounters related to this billed item.">encounter</a><a name="Claim.item.encounter"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item.service" title="If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RXNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. "glasses" or "compound".">service</a><a name="Claim.item.service"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="font-weight:bold">Binding: </span><a href="http://hl7.org/fhir/STU3/valueset-service-uscls.html">USCLS Codes</a> (<a href="http://hl7.org/fhir/STU3/terminologies.html#example" title="Instances are not expected or even encouraged to draw from the specified value set. The value set merely provides examples of the types of concepts intended to be included.">example</a>)</td></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item.serviced[x]" title="The date or dates when the enclosed suite of services were performed or completed.">serviced[x]</a><a name="Claim.item.serviced_x_"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item.locationReference" title="Where the service was provided.">locationReference</a><a name="Claim.item.locationReference"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item.udi" title="List of Unique Device Identifiers associated with this line item.">udi</a><a name="Claim.item.udi"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-device)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck101.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item.detail" title="Second tier of goods and services.">detail</a><a name="Claim.item.detail"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1010.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item.detail.udi" title="List of Unique Device Identifiers associated with this line item.">udi</a><a name="Claim.item.detail.udi"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-device)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1001.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item.detail.subDetail" title="Third tier of goods and services.">subDetail</a><a name="Claim.item.detail.subDetail"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10000.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.item.detail.subDetail.udi" title="List of Unique Device Identifiers associated with this line item.">udi</a><a name="Claim.item.detail.subDetail.udi"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/references.html">Reference</a>(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-device)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.information" title="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.">information</a><a name="Claim.information"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.information.category" title="The general class of the information supplied: information; exception; accident, employment; onset, etc.">category</a><a name="Claim.information.category"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="font-weight:bold">Binding: </span><a href="http://hl7.org/fhir/STU3/valueset-claim-informationcategory.html">Claim Information Category Codes</a> (<a href="http://hl7.org/fhir/STU3/terminologies.html#example" title="Instances are not expected or even encouraged to draw from the specified value set. The value set merely provides examples of the types of concepts intended to be included.">example</a>)</td></tr> <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white;"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-qicore-claim-definitions.html#Claim.information.code" title="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication.">code</a><a name="Claim.information.code"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/STU3/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="font-weight:bold">Binding: </span><a href="http://hl7.org/fhir/STU3/valueset-claim-exception.html">Exception Codes</a> (<a href="http://hl7.org/fhir/STU3/terminologies.html#example" title="Instances are not expected or even encouraged to draw from the specified value set. The value set merely provides examples of the types of concepts intended to be included.">example</a>)</td></tr> <tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/STU3/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/STU3/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div> </text> <url value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"/> <version value="3.2.0"/> <name value="QICore-Claim"/> <status value="draft"/> <experimental value="false"/> <date value="2018-08-22T00:00:00+10:00"/> <publisher value="Health Level Seven, Inc. - CQI WG"/> <contact> <telecom> <system value="url"/> <value value="http://hl7.org/special/committees/CQI"/> </telecom> </contact> <description value="Profile of Claim for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors."/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="us"/> </coding> </jurisdiction> <fhirVersion value="3.0.1"/> <mapping> <identity value="workflow"/> <uri value="http://hl7.org/fhir/workflow"/> <name value="Workflow Mapping"/> </mapping> <mapping> <identity value="w5"/> <uri value="http://hl7.org/fhir/w5"/> <name value="W5 Mapping"/> </mapping> <mapping> <identity value="rim"/> <uri value="http://hl7.org/v3"/> <name value="RIM Mapping"/> </mapping> <kind value="resource"/> <abstract value="false"/> <type value="Claim"/> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Claim"/> <derivation value="constraint"/> <snapshot> <element id="Claim"> <path value="Claim"/> <short value="Claim, Pre-determination or Pre-authorization"/> <definition value="A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery."/> <min value="0"/> <max value="*"/> <base> <path value="Claim"/> <min value="0"/> <max value="*"/> </base> <constraint> <key value="dom-2"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/> <expression value="contained.contained.empty()"/> <xpath value="not(parent::f:contained and f:contained)"/> <source value="DomainResource"/> </constraint> <constraint> <key value="dom-1"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL NOT contain any narrative"/> <expression value="contained.text.empty()"/> <xpath value="not(parent::f:contained and f:text)"/> <source value="DomainResource"/> </constraint> <constraint> <key value="dom-4"/> <severity value="error"/> <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/> <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/> <xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/> <source value="DomainResource"/> </constraint> <constraint> <key value="dom-3"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource"/> <expression value="contained.where(('#'+id in %resource.descendants().reference).not()).empty()"/> <xpath value="not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))"/> <source value="DomainResource"/> </constraint> <mustSupport value="false"/> <mapping> <identity value="rim"/> <map value="Entity. Role, or Act"/> </mapping> <mapping> <identity value="workflow"/> <map value="Request"/> </mapping> <mapping> <identity value="w5"/> <map value="financial.billing"/> </mapping> </element> <element id="Claim.id"> <path value="Claim.id"/> <short value="Logical id of this artifact"/> <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/> <comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="id"/> </type> <isSummary value="true"/> </element> <element id="Claim.meta"> <path value="Claim.meta"/> <short value="Metadata about the resource"/> <definition value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.meta"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Meta"/> </type> <isSummary value="true"/> </element> <element id="Claim.implicitRules"> <path value="Claim.implicitRules"/> <short value="A set of rules under which this content was created"/> <definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content."/> <comment value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.implicitRules"/> <min value="0"/> <max value="1"/> </base> <type> <code value="uri"/> </type> <isModifier value="true"/> <isSummary value="true"/> </element> <element id="Claim.language"> <path value="Claim.language"/> <short value="Language of the resource content"/> <definition value="The base language in which the resource is written."/> <comment value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.language"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet"> <valueReference> <reference value="http://hl7.org/fhir/ValueSet/all-languages"/> </valueReference> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Language"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding"> <valueBoolean value="true"/> </extension> <strength value="extensible"/> <description value="A human language."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/languages"/> </valueSetReference> </binding> </element> <element id="Claim.text"> <path value="Claim.text"/> <short value="Text summary of the resource, for human interpretation"/> <definition value="A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/> <comment value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later."/> <alias value="narrative"/> <alias value="html"/> <alias value="xhtml"/> <alias value="display"/> <min value="0"/> <max value="1"/> <base> <path value="DomainResource.text"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Narrative"/> </type> <condition value="dom-1"/> <mapping> <identity value="rim"/> <map value="Act.text?"/> </mapping> </element> <element id="Claim.contained"> <path value="Claim.contained"/> <short value="Contained, inline Resources"/> <definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope."/> <comment value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again."/> <alias value="inline resources"/> <alias value="anonymous resources"/> <alias value="contained resources"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.contained"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Resource"/> </type> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.extension"> <path value="Claim.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.modifierExtension"> <path value="Claim.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.identifier"> <path value="Claim.identifier"/> <short value="Claim number"/> <definition value="The business identifier for the instance: claim number, pre-determination or pre-authorization number."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.identifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Identifier"/> </type> <mapping> <identity value="workflow"/> <map value="Request.identifier"/> </mapping> <mapping> <identity value="w5"/> <map value="id"/> </mapping> </element> <element id="Claim.status"> <path value="Claim.status"/> <short value="active | cancelled | draft | entered-in-error"/> <definition value="The status of the resource instance."/> <comment value="This element is labeled as a modifier because the status contains the code entered-in-error that marks the claim as not currently valid."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.status"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <isModifier value="true"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ClaimStatus"/> </extension> <strength value="required"/> <description value="A code specifying the state of the resource instance."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/fm-status"/> </valueSetReference> </binding> <mapping> <identity value="workflow"/> <map value="Request.status"/> </mapping> <mapping> <identity value="w5"/> <map value="status"/> </mapping> </element> <element id="Claim.type"> <path value="Claim.type"/> <short value="Type or discipline"/> <definition value="The category of claim, eg, oral, pharmacy, vision, insitutional, professional."/> <comment value="Affects which fields and value sets are used."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ClaimType"/> </extension> <strength value="required"/> <description value="The type or discipline-style of the claim"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-type"/> </valueSetReference> </binding> <mapping> <identity value="w5"/> <map value="class"/> </mapping> </element> <element id="Claim.subType"> <path value="Claim.subType"/> <short value="Finer grained claim type information"/> <definition value="A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType."/> <comment value="This may contain the local bill type codes such as the US UB-04 bill type code."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.subType"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ClaimSubType"/> </extension> <strength value="example"/> <description value="A more granular claim typecode"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-subtype"/> </valueSetReference> </binding> <mapping> <identity value="w5"/> <map value="class"/> </mapping> </element> <element id="Claim.use"> <path value="Claim.use"/> <short value="complete | proposed | exploratory | other"/> <definition value="Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination)."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.use"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Use"/> </extension> <strength value="required"/> <description value="Complete, proposed, exploratory, other"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-use"/> </valueSetReference> </binding> <mapping> <identity value="w5"/> <map value="class"/> </mapping> </element> <element id="Claim.patient"> <path value="Claim.patient"/> <short value="The subject of the Products and Services"/> <definition value="Patient Resource."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.patient"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/> </type> <mustSupport value="true"/> <mapping> <identity value="workflow"/> <map value="Request.subject"/> </mapping> <mapping> <identity value="w5"/> <map value="who.focus"/> </mapping> </element> <element id="Claim.billablePeriod"> <path value="Claim.billablePeriod"/> <short value="Period for charge submission"/> <definition value="The billable period for which charges are being submitted."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.billablePeriod"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <mapping> <identity value="w5"/> <map value="when.done"/> </mapping> </element> <element id="Claim.created"> <path value="Claim.created"/> <short value="Creation date"/> <definition value="The date when the enclosed suite of services were performed or completed."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.created"/> <min value="0"/> <max value="1"/> </base> <type> <code value="dateTime"/> </type> <mustSupport value="true"/> <mapping> <identity value="workflow"/> <map value="Request.authoredOn"/> </mapping> <mapping> <identity value="w5"/> <map value="when.recorded"/> </mapping> </element> <element id="Claim.enterer"> <path value="Claim.enterer"/> <short value="Author"/> <definition value="Person who created the invoice/claim/pre-determination or pre-authorization."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.enterer"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> </type> <mapping> <identity value="w5"/> <map value="who.author"/> </mapping> </element> <element id="Claim.insurer"> <path value="Claim.insurer"/> <short value="Target"/> <definition value="The Insurer who is target of the request."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.insurer"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> </type> <mapping> <identity value="workflow"/> <map value="Request.performer"/> </mapping> </element> <element id="Claim.provider"> <path value="Claim.provider"/> <short value="Responsible provider"/> <definition value="The provider which is responsible for the bill, claim pre-determination, pre-authorization."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.provider"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner"/> </type> <mustSupport value="true"/> <mapping> <identity value="workflow"/> <map value="Request.requester.agent"/> </mapping> <mapping> <identity value="w5"/> <map value="who.source"/> </mapping> </element> <element id="Claim.organization"> <path value="Claim.organization"/> <short value="Responsible organization"/> <definition value="The organization which is responsible for the bill, claim pre-determination, pre-authorization."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.organization"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> </type> <mapping> <identity value="workflow"/> <map value="Request.requester.onBehalfOf"/> </mapping> <mapping> <identity value="w5"/> <map value="who.source"/> </mapping> </element> <element id="Claim.priority"> <path value="Claim.priority"/> <short value="Desired processing priority"/> <definition value="Immediate (STAT), best effort (NORMAL), deferred (DEFER)."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.priority"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProcessPriority"/> </extension> <strength value="example"/> <description value="The timeliness with which processing is required: STAT, normal, Deferred"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/process-priority"/> </valueSetReference> </binding> <mapping> <identity value="workflow"/> <map value="Request.priority"/> </mapping> </element> <element id="Claim.fundsReserve"> <path value="Claim.fundsReserve"/> <short value="Funds requested to be reserved"/> <definition value="In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.fundsReserve"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="FundsReserve"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding"> <valueBoolean value="true"/> </extension> <strength value="example"/> <description value="For whom funds are to be reserved: (Patient, Provider, None)."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/fundsreserve"/> </valueSetReference> </binding> </element> <element id="Claim.related"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="RelatedClaim"/> </extension> <path value="Claim.related"/> <short value="Related Claims which may be revelant to processing this claimn"/> <definition value="Other claims which are related to this claim such as prior claim versions or for related services."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.related"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> </element> <element id="Claim.related.id"> <path value="Claim.related.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.related.extension"> <path value="Claim.related.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.related.modifierExtension"> <path value="Claim.related.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.related.claim"> <path value="Claim.related.claim"/> <short value="Reference to the related claim"/> <definition value="Other claims which are related to this claim such as prior claim versions or for related services."/> <comment value="Do we need a relationship code?"/> <min value="0"/> <max value="1"/> <base> <path value="Claim.related.claim"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Claim"/> </type> <mapping> <identity value="workflow"/> <map value="Request.replaces"/> </mapping> </element> <element id="Claim.related.relationship"> <path value="Claim.related.relationship"/> <short value="How the reference claim is related"/> <definition value="For example prior or umbrella."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.related.relationship"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RelatedClaimRelationship"/> </extension> <strength value="example"/> <description value="Relationship of this claim to a related Claim"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/related-claim-relationship"/> </valueSetReference> </binding> </element> <element id="Claim.related.reference"> <path value="Claim.related.reference"/> <short value="Related file or case reference"/> <definition value="An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # ."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.related.reference"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> </element> <element id="Claim.prescription"> <path value="Claim.prescription"/> <short value="Prescription authorizing services or products"/> <definition value="Prescription to support the dispensing of Pharmacy or Vision products."/> <comment value="Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence."/> <requirements value="For type=Pharmacy and Vision only."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.prescription"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/VisionPrescription"/> </type> <mustSupport value="true"/> </element> <element id="Claim.originalPrescription"> <path value="Claim.originalPrescription"/> <short value="Original prescription if superceded by fulfiller"/> <definition value="Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'."/> <comment value="as above."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.originalPrescription"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/> </type> </element> <element id="Claim.payee"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Payee"/> </extension> <path value="Claim.payee"/> <short value="Party to be paid any benefits payable"/> <definition value="The party to be reimbursed for the services."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.payee"/> <min value="0"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> <mustSupport value="false"/> </element> <element id="Claim.payee.id"> <path value="Claim.payee.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.payee.extension"> <path value="Claim.payee.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.payee.modifierExtension"> <path value="Claim.payee.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.payee.type"> <path value="Claim.payee.type"/> <short value="Type of party: Subscriber, Provider, other"/> <definition value="Type of Party to be reimbursed: Subscriber, provider, other."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.payee.type"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="PayeeType"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding"> <valueBoolean value="true"/> </extension> <strength value="example"/> <description value="A code for the party to be reimbursed."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/payeetype"/> </valueSetReference> </binding> </element> <element id="Claim.payee.resourceType"> <path value="Claim.payee.resourceType"/> <short value="organization | patient | practitioner | relatedperson"/> <definition value="organization | patient | practitioner | relatedperson."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.payee.resourceType"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Coding"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ClaimPayeeResourceType"/> </extension> <strength value="example"/> <description value="The type of Claim payee Resource"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-payee-resource-type"/> </valueSetReference> </binding> </element> <element id="Claim.payee.party"> <path value="Claim.payee.party"/> <short value="Party to receive the payable"/> <definition value="Party to be reimbursed: Subscriber, provider, other."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.payee.party"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson"/> </type> <mustSupport value="false"/> </element> <element id="Claim.referral"> <path value="Claim.referral"/> <short value="Treatment Referral"/> <definition value="The referral resource which lists the date, practitioner, reason and other supporting information."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.referral"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-referralrequest"/> </type> <mustSupport value="false"/> <mapping> <identity value="w5"/> <map value="who.cause"/> </mapping> </element> <element id="Claim.facility"> <path value="Claim.facility"/> <short value="Servicing Facility"/> <definition value="Facility where the services were provided."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.facility"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location"/> </type> <mapping> <identity value="w5"/> <map value="where"/> </mapping> </element> <element id="Claim.careTeam"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="CareTeam"/> </extension> <path value="Claim.careTeam"/> <short value="Members of the care team"/> <definition value="The members of the team who provided the overall service as well as their role and whether responsible and qualifications."/> <requirements value="Role and Responsible may not be required when there is only a single provider listed."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.careTeam"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> <mustSupport value="false"/> </element> <element id="Claim.careTeam.id"> <path value="Claim.careTeam.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.careTeam.extension"> <path value="Claim.careTeam.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.careTeam.modifierExtension"> <path value="Claim.careTeam.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.careTeam.sequence"> <path value="Claim.careTeam.sequence"/> <short value="Number to covey order of careTeam"/> <definition value="Sequence of the careTeam which serves to order and provide a link."/> <requirements value="Required to maintain order of the careTeam."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.careTeam.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.careTeam.provider"> <path value="Claim.careTeam.provider"/> <short value="Provider individual or organization"/> <definition value="Member of the team who provided the overall service."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.careTeam.provider"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization"/> </type> <mustSupport value="false"/> <mapping> <identity value="w5"/> <map value="who.actor"/> </mapping> </element> <element id="Claim.careTeam.responsible"> <path value="Claim.careTeam.responsible"/> <short value="Billing provider"/> <definition value="The party who is billing and responsible for the claimed good or service rendered to the patient."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.careTeam.responsible"/> <min value="0"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> </element> <element id="Claim.careTeam.role"> <path value="Claim.careTeam.role"/> <short value="Role on the team"/> <definition value="The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.careTeam.role"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CareTeamRole"/> </extension> <strength value="example"/> <description value="The role codes for the care team members."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-careteamrole"/> </valueSetReference> </binding> </element> <element id="Claim.careTeam.qualification"> <path value="Claim.careTeam.qualification"/> <short value="Type, classification or Specialization"/> <definition value="The qualification which is applicable for this service."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.careTeam.qualification"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProviderQualification"/> </extension> <strength value="example"/> <description value="Provider professional qualifications"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/provider-qualification"/> </valueSetReference> </binding> </element> <element id="Claim.information"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="SpecialCondition"/> </extension> <path value="Claim.information"/> <short value="Exceptions, special considerations, the condition, situation, prior or concurrent issues"/> <definition value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required."/> <requirements value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.information"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> <mustSupport value="false"/> <mapping> <identity value="workflow"/> <map value="Request.supportingInfo"/> </mapping> </element> <element id="Claim.information.id"> <path value="Claim.information.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.information.extension"> <path value="Claim.information.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.information.modifierExtension"> <path value="Claim.information.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.information.sequence"> <path value="Claim.information.sequence"/> <short value="Information instance identifier"/> <definition value="Sequence of the information element which serves to provide a link."/> <requirements value="To provide a reference link."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.information.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.information.category"> <path value="Claim.information.category"/> <short value="General class of information"/> <definition value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/> <comment value="This may contain the local bill type codes such as the US UB-04 bill type code."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.information.category"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <mustSupport value="true"/> <binding> <strength value="example"/> <description value="This value set includes sample Information Category codes."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-informationcategory"/> </valueSetReference> </binding> </element> <element id="Claim.information.code"> <path value="Claim.information.code"/> <short value="Type of information"/> <definition value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication."/> <comment value="This may contain the local bill type codes such as the US UB-04 bill type code."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.information.code"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <mustSupport value="true"/> <binding> <strength value="example"/> <description value="This value set includes sample Exception codes."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-exception"/> </valueSetReference> </binding> </element> <element id="Claim.information.timing[x]"> <path value="Claim.information.timing[x]"/> <short value="When it occurred"/> <definition value="The date when or period to which this information refers."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.information.timing[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="date"/> </type> <type> <code value="Period"/> </type> </element> <element id="Claim.information.value[x]"> <path value="Claim.information.value[x]"/> <short value="Additional Data or supporting information"/> <definition value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.information.value[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <type> <code value="Quantity"/> </type> <type> <code value="Attachment"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/> </type> </element> <element id="Claim.information.reason"> <path value="Claim.information.reason"/> <short value="Reason associated with the information"/> <definition value="For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.information.reason"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="MissingReason"/> </extension> <strength value="example"/> <description value="Reason codes for the missing teeth"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/> </valueSetReference> </binding> </element> <element id="Claim.diagnosis"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Diagnosis"/> </extension> <path value="Claim.diagnosis"/> <short value="List of Diagnosis"/> <definition value="List of patient diagnosis for which care is sought."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.diagnosis"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> <mustSupport value="false"/> <mapping> <identity value="workflow"/> <map value="Request.reasonReference"/> </mapping> </element> <element id="Claim.diagnosis.id"> <path value="Claim.diagnosis.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.diagnosis.extension"> <path value="Claim.diagnosis.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.diagnosis.modifierExtension"> <path value="Claim.diagnosis.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.diagnosis.sequence"> <path value="Claim.diagnosis.sequence"/> <short value="Number to covey order of diagnosis"/> <definition value="Sequence of diagnosis which serves to provide a link."/> <requirements value="Required to allow line items to reference the diagnoses."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.diagnosis.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.diagnosis.diagnosis[x]"> <path value="Claim.diagnosis.diagnosis[x]"/> <short value="Patient's diagnosis"/> <definition value="The diagnosis."/> <requirements value="Required to adjudicate services rendered to condition presented."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.diagnosis.diagnosis[x]"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ICD10"/> </extension> <strength value="example"/> <description value="ICD10 Diagnostic codes"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/icd-10"/> </valueSetReference> </binding> </element> <element id="Claim.diagnosis.type"> <path value="Claim.diagnosis.type"/> <short value="Timing or nature of the diagnosis"/> <definition value="The type of the Diagnosis, for example: admitting, primary, secondary, discharge."/> <comment value="Diagnosis are presented in list order to their expected importance: primary, secondary, etc."/> <requirements value="May be required to adjudicate services rendered."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.diagnosis.type"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <mustSupport value="false"/> <binding> <strength value="example"/> <description value="This value set includes example Diagnosis Type codes."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-diagnosistype"/> </valueSetReference> </binding> </element> <element id="Claim.diagnosis.packageCode"> <path value="Claim.diagnosis.packageCode"/> <short value="Package billing code"/> <definition value="The package billing code, for example DRG, based on the assigned grouping code system."/> <requirements value="May be required to adjudicate services rendered to the mandated grouping system."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.diagnosis.packageCode"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="DiagnosisRelatedGroup"/> </extension> <strength value="example"/> <description value="The DRG codes associated with the diagnosis"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup"/> </valueSetReference> </binding> </element> <element id="Claim.procedure"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Procedure"/> </extension> <path value="Claim.procedure"/> <short value="Procedures performed"/> <definition value="Procedures performed."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.procedure"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> <mustSupport value="true"/> </element> <element id="Claim.procedure.id"> <path value="Claim.procedure.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.procedure.extension"> <path value="Claim.procedure.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.procedure.modifierExtension"> <path value="Claim.procedure.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.procedure.sequence"> <path value="Claim.procedure.sequence"/> <short value="Procedure sequence for reference"/> <definition value="Procedure sequence for reference."/> <requirements value="Required to maintain order of the procudures."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.procedure.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <mustSupport value="true"/> </element> <element id="Claim.procedure.date"> <path value="Claim.procedure.date"/> <short value="When the procedure was performed"/> <definition value="When the procedure was performed."/> <comment value="SB DateTime??"/> <requirements value="Required to adjudicate services rendered."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.procedure.date"/> <min value="0"/> <max value="1"/> </base> <type> <code value="dateTime"/> </type> <mustSupport value="true"/> </element> <element id="Claim.procedure.procedure[x]"> <path value="Claim.procedure.procedure[x]"/> <short value="Patient's list of procedures performed"/> <definition value="When the procedure was performed."/> <requirements value="Required to adjudicate services rendered."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.procedure.procedure[x]"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Procedure"/> </type> <mustSupport value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ICD10_Procedures"/> </extension> <strength value="example"/> <description value="ICD10 Procedure codes"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/icd-10-procedures"/> </valueSetReference> </binding> </element> <element id="Claim.insurance"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Insurance"/> </extension> <path value="Claim.insurance"/> <short value="Insurance or medical plan"/> <definition value="Financial instrument by which payment information for health care."/> <requirements value="Health care programs and insurers are significant payors of health service costs."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.insurance"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> <mapping> <identity value="rim"/> <map value="Coverage"/> </mapping> </element> <element id="Claim.insurance.id"> <path value="Claim.insurance.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.insurance.extension"> <path value="Claim.insurance.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.insurance.modifierExtension"> <path value="Claim.insurance.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.insurance.sequence"> <path value="Claim.insurance.sequence"/> <short value="Service instance identifier"/> <definition value="Sequence of coverage which serves to provide a link and convey coordination of benefit order."/> <requirements value="To maintain order of the coverages."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.insurance.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.insurance.focal"> <path value="Claim.insurance.focal"/> <short value="Is the focal Coverage"/> <definition value="A flag to indicate that this Coverage is the focus for adjudication. The Coverage against which the claim is to be adjudicated."/> <requirements value="To identify which coverage is being adjudicated."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.insurance.focal"/> <min value="1"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> </element> <element id="Claim.insurance.coverage"> <path value="Claim.insurance.coverage"/> <short value="Insurance information"/> <definition value="Reference to the program or plan identification, underwriter or payor."/> <requirements value="Need to identify the issuer to target for processing and for coordination of benefit processing."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.insurance.coverage"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Coverage"/> </type> </element> <element id="Claim.insurance.businessArrangement"> <path value="Claim.insurance.businessArrangement"/> <short value="Business agreement"/> <definition value="The contract number of a business agreement which describes the terms and conditions."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.insurance.businessArrangement"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> </element> <element id="Claim.insurance.preAuthRef"> <path value="Claim.insurance.preAuthRef"/> <short value="Pre-Authorization/Determination Reference"/> <definition value="A list of references from the Insurer to which these services pertain."/> <requirements value="To provide any pre=determination or prior authorization reference."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.insurance.preAuthRef"/> <min value="0"/> <max value="*"/> </base> <type> <code value="string"/> </type> </element> <element id="Claim.insurance.claimResponse"> <path value="Claim.insurance.claimResponse"/> <short value="Adjudication results"/> <definition value="The Coverages adjudication details."/> <requirements value="Used by downstream payers to determine what balance remains and the net payable."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.insurance.claimResponse"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/ClaimResponse"/> </type> </element> <element id="Claim.accident"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Accident"/> </extension> <path value="Claim.accident"/> <short value="Details about an accident"/> <definition value="An accident which resulted in the need for healthcare services."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.accident"/> <min value="0"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> </element> <element id="Claim.accident.id"> <path value="Claim.accident.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.accident.extension"> <path value="Claim.accident.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.accident.modifierExtension"> <path value="Claim.accident.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.accident.date"> <path value="Claim.accident.date"/> <short value="When the accident occurred see information codes see information codes"/> <definition value="Date of an accident which these services are addressing."/> <requirements value="Coverage may be dependant on accidents."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.accident.date"/> <min value="1"/> <max value="1"/> </base> <type> <code value="date"/> </type> </element> <element id="Claim.accident.type"> <path value="Claim.accident.type"/> <short value="The nature of the accident"/> <definition value="Type of accident: work, auto, etc."/> <requirements value="Coverage may be dependant on the type of accident."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.accident.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AccidentType"/> </extension> <strength value="required"/> <description value="Type of accident: work place, auto, etc."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/v3-ActIncidentCode"/> </valueSetReference> </binding> </element> <element id="Claim.accident.location[x]"> <path value="Claim.accident.location[x]"/> <short value="Accident Place"/> <definition value="Accident Place."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.accident.location[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Address"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location"/> </type> </element> <element id="Claim.employmentImpacted"> <path value="Claim.employmentImpacted"/> <short value="Period unable to work"/> <definition value="The start and optional end dates of when the patient was precluded from working due to the treatable condition(s)."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.employmentImpacted"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> </element> <element id="Claim.hospitalization"> <path value="Claim.hospitalization"/> <short value="Period in hospital"/> <definition value="Period in hospital."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.hospitalization"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <mustSupport value="true"/> </element> <element id="Claim.item"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Item"/> </extension> <path value="Claim.item"/> <short value="Goods and Services"/> <definition value="First tier of goods and services."/> <min value="1"/> <max value="*"/> <base> <path value="Claim.item"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> <mustSupport value="true"/> </element> <element id="Claim.item.id"> <path value="Claim.item.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.item.extension"> <path value="Claim.item.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.item.modifierExtension"> <path value="Claim.item.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.item.sequence"> <path value="Claim.item.sequence"/> <short value="Service instance"/> <definition value="A service line number."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.item.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.item.careTeamLinkId"> <path value="Claim.item.careTeamLinkId"/> <short value="Applicable careTeam members"/> <definition value="CareTeam applicable for this service or product line."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.careTeamLinkId"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.item.diagnosisLinkId"> <path value="Claim.item.diagnosisLinkId"/> <short value="Applicable diagnoses"/> <definition value="Diagnosis applicable for this service or product line."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.diagnosisLinkId"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.item.procedureLinkId"> <path value="Claim.item.procedureLinkId"/> <short value="Applicable procedures"/> <definition value="Procedures applicable for this service or product line."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.procedureLinkId"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.item.informationLinkId"> <path value="Claim.item.informationLinkId"/> <short value="Applicable exception and supporting information"/> <definition value="Exceptions, special conditions and supporting information pplicable for this service or product line."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.informationLinkId"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.item.revenue"> <path value="Claim.item.revenue"/> <short value="Revenue or cost center code"/> <definition value="The type of reveneu or cost center providing the product and/or service."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.revenue"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RevenueCenter"/> </extension> <strength value="example"/> <description value="Codes for the revenue or cost centers supplying the service and/or products."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-revenue-center"/> </valueSetReference> </binding> </element> <element id="Claim.item.category"> <path value="Claim.item.category"/> <short value="Type of service or product"/> <definition value="Health Care Service Type Codes to identify the classification of service or benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.category"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitSubCategory"/> </extension> <strength value="example"/> <description value="Benefit subcategories such as: oral-basic, major, glasses"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/benefit-subcategory"/> </valueSetReference> </binding> </element> <element id="Claim.item.service"> <path value="Claim.item.service"/> <short value="Billing Code"/> <definition value="If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RXNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. "glasses" or "compound"."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.item.service"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <mustSupport value="true"/> <binding> <strength value="example"/> <description value="This value set includes a smattering of USCLS codes."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/service-uscls"/> </valueSetReference> </binding> </element> <element id="Claim.item.modifier"> <path value="Claim.item.modifier"/> <short value="Service/Product billing modifiers"/> <definition value="Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours."/> <requirements value="May impact on adjudication."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.modifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers"/> </extension> <strength value="example"/> <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-modifiers"/> </valueSetReference> </binding> </element> <element id="Claim.item.programCode"> <path value="Claim.item.programCode"/> <short value="Program specific reason for item inclusion"/> <definition value="For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.programCode"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProgramCode"/> </extension> <strength value="example"/> <description value="Program specific reason codes"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-program-code"/> </valueSetReference> </binding> </element> <element id="Claim.item.serviced[x]"> <path value="Claim.item.serviced[x]"/> <short value="Date or dates of Service"/> <definition value="The date or dates when the enclosed suite of services were performed or completed."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.item.serviced[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="date"/> </type> <type> <code value="Period"/> </type> <mustSupport value="true"/> <mapping> <identity value="w5"/> <map value="when.done"/> </mapping> </element> <element id="Claim.item.locationReference"> <path value="Claim.item.locationReference"/> <short value="Place of service"/> <definition value="Where the service was provided."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.location[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location"/> </type> <mustSupport value="false"/> <mapping> <identity value="w5"/> <map value="where"/> </mapping> </element> <element id="Claim.item.quantity"> <path value="Claim.item.quantity"/> <short value="Count of Products or Services"/> <definition value="The number of repetitions of a service or product."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.quantity"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> </type> </element> <element id="Claim.item.unitPrice"> <path value="Claim.item.unitPrice"/> <short value="Fee, charge or cost per point"/> <definition value="If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.unitPrice"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> </element> <element id="Claim.item.factor"> <path value="Claim.item.factor"/> <short value="Price scaling factor"/> <definition value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/> <requirements value="If a fee is present the associated product/service code must be present."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.factor"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> </element> <element id="Claim.item.net"> <path value="Claim.item.net"/> <short value="Total item cost"/> <definition value="The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied."/> <requirements value="If a fee is present the associated product/service code must be present."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.net"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> </element> <element id="Claim.item.udi"> <path value="Claim.item.udi"/> <short value="Unique Device Identifier"/> <definition value="List of Unique Device Identifiers associated with this line item."/> <requirements value="The UDI code and issuer if applicable for the supplied product."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.udi"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-device"/> </type> <mustSupport value="false"/> </element> <element id="Claim.item.bodySite"> <path value="Claim.item.bodySite"/> <short value="Service Location"/> <definition value="Physical service site on the patient (limb, tooth, etc)."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.bodySite"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="OralSites"/> </extension> <strength value="example"/> <description value="The code for the teeth, quadrant, sextant and arch"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/tooth"/> </valueSetReference> </binding> </element> <element id="Claim.item.subSite"> <path value="Claim.item.subSite"/> <short value="Service Sub-location"/> <definition value="A region or surface of the site, eg. limb region or tooth surface(s)."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.subSite"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Surface"/> </extension> <strength value="example"/> <description value="The code for the tooth surface and surface combinations"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/surface"/> </valueSetReference> </binding> </element> <element id="Claim.item.encounter"> <path value="Claim.item.encounter"/> <short value="Encounters related to this billed item"/> <definition value="Encounters related to this billed item."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.encounter"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/> </type> <mustSupport value="true"/> <mapping> <identity value="workflow"/> <map value="Request.context"/> </mapping> </element> <element id="Claim.item.detail"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Detail"/> </extension> <path value="Claim.item.detail"/> <short value="Additional items"/> <definition value="Second tier of goods and services."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.detail"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> <mustSupport value="false"/> </element> <element id="Claim.item.detail.id"> <path value="Claim.item.detail.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.item.detail.extension"> <path value="Claim.item.detail.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.item.detail.modifierExtension"> <path value="Claim.item.detail.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.item.detail.sequence"> <path value="Claim.item.detail.sequence"/> <short value="Service instance"/> <definition value="A service line number."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.item.detail.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.item.detail.revenue"> <path value="Claim.item.detail.revenue"/> <short value="Revenue or cost center code"/> <definition value="The type of reveneu or cost center providing the product and/or service."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.revenue"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RevenueCenter"/> </extension> <strength value="example"/> <description value="Codes for the revenue or cost centers supplying the service and/or products."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-revenue-center"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.category"> <path value="Claim.item.detail.category"/> <short value="Type of service or product"/> <definition value="Health Care Service Type Codes to identify the classification of service or benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.category"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitSubCategory"/> </extension> <strength value="example"/> <description value="Benefit subcategories such as: oral-basic, major, glasses"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/benefit-subcategory"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.service"> <path value="Claim.item.detail.service"/> <short value="Billing Code"/> <definition value="If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.service"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct"/> </extension> <strength value="example"/> <description value="Allowable service and product codes"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/service-uscls"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.modifier"> <path value="Claim.item.detail.modifier"/> <short value="Service/Product billing modifiers"/> <definition value="Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours."/> <requirements value="May impact on adjudication."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.detail.modifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers"/> </extension> <strength value="example"/> <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-modifiers"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.programCode"> <path value="Claim.item.detail.programCode"/> <short value="Program specific reason for item inclusion"/> <definition value="For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.detail.programCode"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProgramCode"/> </extension> <strength value="example"/> <description value="Program specific reason codes"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-program-code"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.quantity"> <path value="Claim.item.detail.quantity"/> <short value="Count of Products or Services"/> <definition value="The number of repetitions of a service or product."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.quantity"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> </type> </element> <element id="Claim.item.detail.unitPrice"> <path value="Claim.item.detail.unitPrice"/> <short value="Fee, charge or cost per point"/> <definition value="If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group."/> <requirements value="If a fee is present the associated product/service code must be present."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.unitPrice"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> </element> <element id="Claim.item.detail.factor"> <path value="Claim.item.detail.factor"/> <short value="Price scaling factor"/> <definition value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/> <requirements value="If a fee is present the associated product/service code must be present."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.factor"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> </element> <element id="Claim.item.detail.net"> <path value="Claim.item.detail.net"/> <short value="Total additional item cost"/> <definition value="The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied."/> <requirements value="If a fee is present the associated product/service code must be present."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.net"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> </element> <element id="Claim.item.detail.udi"> <path value="Claim.item.detail.udi"/> <short value="Unique Device Identifier"/> <definition value="List of Unique Device Identifiers associated with this line item."/> <requirements value="The UDI code and issuer if applicable for the supplied product."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.detail.udi"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-device"/> </type> <mustSupport value="false"/> </element> <element id="Claim.item.detail.subDetail"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="SubDetail"/> </extension> <path value="Claim.item.detail.subDetail"/> <short value="Additional items"/> <definition value="Third tier of goods and services."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.detail.subDetail"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() | (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="Element"/> </constraint> <mustSupport value="false"/> </element> <element id="Claim.item.detail.subDetail.id"> <path value="Claim.item.detail.subDetail.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.item.detail.subDetail.extension"> <path value="Claim.item.detail.subDetail.extension"/> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="Claim.item.detail.subDetail.modifierExtension"> <path value="Claim.item.detail.subDetail.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <isModifier value="true"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="Claim.item.detail.subDetail.sequence"> <path value="Claim.item.detail.subDetail.sequence"/> <short value="Service instance"/> <definition value="A service line number."/> <min value="1"/> <max value="1"/> <base> <path value="Claim.item.detail.subDetail.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> </element> <element id="Claim.item.detail.subDetail.revenue"> <path value="Claim.item.detail.subDetail.revenue"/> <short value="Revenue or cost center code"/> <definition value="The type of reveneu or cost center providing the product and/or service."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.subDetail.revenue"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RevenueCenter"/> </extension> <strength value="example"/> <description value="Codes for the revenue or cost centers supplying the service and/or products."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-revenue-center"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.subDetail.category"> <path value="Claim.item.detail.subDetail.category"/> <short value="Type of service or product"/> <definition value="Health Care Service Type Codes to identify the classification of service or benefits."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.subDetail.category"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitSubCategory"/> </extension> <strength value="example"/> <description value="Benefit subcategories such as: oral-basic, major, glasses"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/benefit-subcategory"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.subDetail.service"> <path value="Claim.item.detail.subDetail.service"/> <short value="Billing Code"/> <definition value="A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI)."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.subDetail.service"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct"/> </extension> <strength value="example"/> <description value="Allowable service and product codes"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/service-uscls"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.subDetail.modifier"> <path value="Claim.item.detail.subDetail.modifier"/> <short value="Service/Product billing modifiers"/> <definition value="Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours."/> <requirements value="May impact on adjudication."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.detail.subDetail.modifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers"/> </extension> <strength value="example"/> <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-modifiers"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.subDetail.programCode"> <path value="Claim.item.detail.subDetail.programCode"/> <short value="Program specific reason for item inclusion"/> <definition value="For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program."/> <min value="0"/> <max value="*"/> <base> <path value="Claim.item.detail.subDetail.programCode"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProgramCode"/> </extension> <strength value="example"/> <description value="Program specific reason codes"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-program-code"/> </valueSetReference> </binding> </element> <element id="Claim.item.detail.subDetail.quantity"> <path value="Claim.item.detail.subDetail.quantity"/> <short value="Count of Products or Services"/> <definition value="The number of repetitions of a service or product."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.subDetail.quantity"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> </type> </element> <element id="Claim.item.detail.subDetail.unitPrice"> <path value="Claim.item.detail.subDetail.unitPrice"/> <short value="Fee, charge or cost per point"/> <definition value="The fee for an addittional service or product or charge."/> <requirements value="If a fee is present the associated product/service code must be present."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.subDetail.unitPrice"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> </element> <element id="Claim.item.detail.subDetail.factor"> <path value="Claim.item.detail.subDetail.factor"/> <short value="Price scaling factor"/> <definition value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/> <requirements value="If a fee is present the associated product/service code must be present."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.subDetail.factor"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> </element> <element id="Claim.item.detail.subDetail.net"> <path value="Claim.item.detail.subDetail.net"/> <short value="Net additional item cost"/> <definition value="The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied."/> <requirements value="If a fee is present the associated product/service code must be present."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.subDetail.net"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> </element> <element id="Claim.item.detail.subDetail.udi"> <path value="Claim.item.detail.subDetail.udi"/> <short value="Unique Device Identifier"/> <definition value="List of Unique Device Identifiers associated with this line item."/> <requirements value="The UDI code and issuer if applicable for the supplied product."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.item.detail.subDetail.udi"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-device"/> </type> <mustSupport value="false"/> </element> <element id="Claim.total"> <path value="Claim.total"/> <short value="Total claim cost"/> <definition value="The total value of the claim."/> <min value="0"/> <max value="1"/> <base> <path value="Claim.total"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> </element> </snapshot> <differential> <element id="Claim"> <path value="Claim"/> <definition value="A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery."/> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.patient"> <path value="Claim.patient"/> <definition value="Patient Resource."/> <min value="1"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.created"> <path value="Claim.created"/> <definition value="The date when the enclosed suite of services were performed or completed."/> <min value="1"/> <max value="1"/> <type> <code value="dateTime"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.provider"> <path value="Claim.provider"/> <definition value="The provider which is responsible for the bill, claim pre-determination, pre-authorization."/> <min value="1"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.prescription"> <path value="Claim.prescription"/> <definition value="Prescription to support the dispensing of Pharmacy or Vision products."/> <min value="1"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/VisionPrescription"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.payee"> <path value="Claim.payee"/> <definition value="The party to be reimbursed for the services."/> <min value="0"/> <max value="1"/> <type> <code value="BackboneElement"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.payee.party"> <path value="Claim.payee.party"/> <definition value="Party to be reimbursed: Subscriber, provider, other."/> <min value="0"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.referral"> <path value="Claim.referral"/> <definition value="The referral resource which lists the date, practitioner, reason and other supporting information."/> <min value="0"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-referralrequest"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.careTeam"> <path value="Claim.careTeam"/> <definition value="The members of the team who provided the overall service as well as their role and whether responsible and qualifications."/> <min value="0"/> <max value="*"/> <type> <code value="BackboneElement"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.careTeam.provider"> <path value="Claim.careTeam.provider"/> <definition value="Member of the team who provided the overall service."/> <min value="1"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.information"> <path value="Claim.information"/> <definition value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required."/> <min value="0"/> <max value="*"/> <type> <code value="BackboneElement"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.information.category"> <path value="Claim.information.category"/> <definition value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/> <min value="1"/> <max value="1"/> <type> <code value="CodeableConcept"/> </type> <mustSupport value="true"/> <isModifier value="false"/> <binding> <strength value="example"/> <description value="This value set includes sample Information Category codes."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-informationcategory"/> </valueSetReference> </binding> </element> <element id="Claim.information.code"> <path value="Claim.information.code"/> <definition value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication."/> <min value="0"/> <max value="1"/> <type> <code value="CodeableConcept"/> </type> <mustSupport value="true"/> <isModifier value="false"/> <binding> <strength value="example"/> <description value="This value set includes sample Exception codes."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/claim-exception"/> </valueSetReference> </binding> </element> <element id="Claim.diagnosis"> <path value="Claim.diagnosis"/> <definition value="List of patient diagnosis for which care is sought."/> <min value="0"/> <max value="*"/> <type> <code value="BackboneElement"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.diagnosis.type"> <path value="Claim.diagnosis.type"/> <definition value="The type of the Diagnosis, for example: admitting, primary, secondary, discharge."/> <min value="0"/> <max value="*"/> <type> <code value="CodeableConcept"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <binding> <strength value="example"/> <description value="This value set includes example Diagnosis Type codes."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/ex-diagnosistype"/> </valueSetReference> </binding> </element> <element id="Claim.procedure"> <path value="Claim.procedure"/> <definition value="Procedures performed."/> <min value="0"/> <max value="*"/> <type> <code value="BackboneElement"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.procedure.sequence"> <path value="Claim.procedure.sequence"/> <definition value="Procedure sequence for reference."/> <min value="1"/> <max value="1"/> <type> <code value="positiveInt"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.procedure.date"> <path value="Claim.procedure.date"/> <definition value="When the procedure was performed."/> <min value="0"/> <max value="1"/> <type> <code value="dateTime"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.procedure.procedure[x]"> <path value="Claim.procedure.procedure[x]"/> <definition value="When the procedure was performed."/> <min value="1"/> <max value="1"/> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.hospitalization"> <path value="Claim.hospitalization"/> <definition value="Period in hospital."/> <min value="0"/> <max value="1"/> <type> <code value="Period"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.item"> <path value="Claim.item"/> <definition value="First tier of goods and services."/> <min value="1"/> <max value="*"/> <type> <code value="BackboneElement"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.item.service"> <path value="Claim.item.service"/> <definition value="If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RXNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. "glasses" or "compound"."/> <min value="1"/> <max value="1"/> <type> <code value="CodeableConcept"/> </type> <mustSupport value="true"/> <isModifier value="false"/> <binding> <strength value="example"/> <description value="This value set includes a smattering of USCLS codes."/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/service-uscls"/> </valueSetReference> </binding> </element> <element id="Claim.item.serviced[x]"> <path value="Claim.item.serviced[x]"/> <definition value="The date or dates when the enclosed suite of services were performed or completed."/> <min value="1"/> <max value="1"/> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.item.locationReference"> <path value="Claim.item.locationReference"/> <definition value="Where the service was provided."/> <min value="0"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.item.udi"> <path value="Claim.item.udi"/> <definition value="List of Unique Device Identifiers associated with this line item."/> <min value="0"/> <max value="*"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-device"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.item.encounter"> <path value="Claim.item.encounter"/> <definition value="Encounters related to this billed item."/> <min value="0"/> <max value="*"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/> </type> <mustSupport value="true"/> <isModifier value="false"/> </element> <element id="Claim.item.detail"> <path value="Claim.item.detail"/> <definition value="Second tier of goods and services."/> <min value="0"/> <max value="*"/> <type> <code value="BackboneElement"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.item.detail.udi"> <path value="Claim.item.detail.udi"/> <definition value="List of Unique Device Identifiers associated with this line item."/> <min value="0"/> <max value="*"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-device"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.item.detail.subDetail"> <path value="Claim.item.detail.subDetail"/> <definition value="Third tier of goods and services."/> <min value="0"/> <max value="*"/> <type> <code value="BackboneElement"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> <element id="Claim.item.detail.subDetail.udi"> <path value="Claim.item.detail.subDetail.udi"/> <definition value="List of Unique Device Identifiers associated with this line item."/> <min value="0"/> <max value="1"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-device"/> </type> <mustSupport value="false"/> <isModifier value="false"/> </element> </differential> </StructureDefinition>
© HL7.org 2011+. Package hl7.fhir.us.qicore#3.2.0 based on FHIR v3.0.1-11917. Generated on 14/04/2019
Links: Search |
QA Page |
|
Propose a change