QI-Core Implementation Guide
4.1.1 - STU 4.1.1
US
QI-Core Implementation Guide
4.1.1 - STU 4.1.1
US
This page is part of the Quality Improvement Core Framework (v4.1.1: STU 4) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions 
{
"resourceType" : "Claim",
"id" : "example",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"example\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-qicore-claim.html\">QICoreClaim</a></p></div><p><b>identifier</b>: id: 6612346</p><p><b>status</b>: active</p><p><b>type</b>: Vision <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#vision)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-example.html\">Patient/example</a> \" CHALMERS\"</p><p><b>created</b>: 2014-08-16</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization/example</a> \"Health Level Seven International\"</p><p><b>provider</b>: <a href=\"Practitioner-example.html\">Practitioner/example</a> \" CAREFUL\"</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><p><b>prescription</b>: <a href=\"MedicationRequest-example.html\">MedicationRequest/example</a></p><h3>Payees</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td>*</td><td>Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-payeetype.html\">ClaimPayeeTypeCodes</a>#provider)</span></td><td><a href=\"Practitioner-example.html\">Practitioner/example</a> \" CAREFUL\"</td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td>*</td><td>1</td><td><a href=\"Practitioner-example.html\">Practitioner/example</a> \" CAREFUL\"</td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td>*</td><td>1</td><td>654321 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CodeSystem#654321)</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href=\"Coverage-example.html\">Coverage/example</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: glasses <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (ex-visionservice#glasses)</span></p><p><b>serviced</b>: 2014-08-16</p><blockquote><p><b>detail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: frame <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (ex-visionservice#frame)</span></p></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: lens <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (ex-visionservice#lens)</span></p><p><b>quantity</b>: 2</p></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: fst <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (ex-visionservice#fst)</span></p><p><b>factor</b>: 0.07</p></blockquote></blockquote></div>"
},
"identifier" : [
{
"system" : "http://happysight.com/claim",
"value" : "6612346"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "vision"
}
]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/example"
},
"created" : "2014-08-16",
"insurer" : {
"reference" : "Organization/example"
},
"provider" : {
"reference" : "Practitioner/example"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"prescription" : {
"reference" : "MedicationRequest/example"
},
"payee" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
}
]
},
"party" : {
"reference" : "Practitioner/example"
}
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
"reference" : "Practitioner/example"
}
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://example.org/diagnosis/CodeSystem",
"code" : "654321"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/example"
}
}
],
"item" : [
{
"sequence" : 1,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/CodeSystem/ex-visionservice",
"code" : "glasses"
}
]
},
"servicedDate" : "2014-08-16",
"unitPrice" : {
"value" : 214.00,
"currency" : "USD"
},
"detail" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/CodeSystem/ex-visionservice",
"code" : "frame"
}
]
},
"unitPrice" : {
"value" : 100.00,
"currency" : "USD"
},
"net" : {
"value" : 100.00,
"currency" : "USD"
}
},
{
"sequence" : 2,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/CodeSystem/ex-visionservice",
"code" : "lens"
}
]
},
"quantity" : {
"value" : 2
},
"unitPrice" : {
"value" : 50.00,
"currency" : "USD"
},
"net" : {
"value" : 100.00,
"currency" : "USD"
}
},
{
"sequence" : 3,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/CodeSystem/ex-visionservice",
"code" : "fst"
}
]
},
"unitPrice" : {
"value" : 200.00,
"currency" : "USD"
},
"factor" : 0.07,
"net" : {
"value" : 14.00,
"currency" : "USD"
}
}
]
}
]
}
IG © 2019+ http://www.hl7.org/Special/committees/cqi/index.cfm. Package hl7.fhir.us.qicore#4.1.1 based on FHIR 4.0.1. Generated 2022-03-31
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