QI-Core Implementation Guide: STU 4 (v4.0.0 for FHIR 4.0.1)

QI-Core Implementation Guide - This is the current published version.. See the Directory of published versions

D.4.1 StructureDefinition-qicore-claim

Introduction:

See the patterns page for implementation and usage patterns.

Examples:

Simple Vision Claim

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is: 

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

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

This profile builds on Claim.

This profile was published on Wed Aug 22 00:00:00 UTC 2018 as a draft by Health Level Seven, Inc. - CQI WG.

Description of Profiles, Differentials, and Snapshots.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim I0..*ClaimClaim, Pre-determination or Pre-authorization
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier I0..*IdentifierBusiness Identifier for claim
... status ?!ΣI1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type ΣI1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (extensible)
... subType I0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example)
... use ΣI1..1codeclaim | preauthorization | predetermination
Binding: Use (required)
... patient SΣI1..1Reference(QICorePatient)The recipient of the products and services
... billablePeriod SΣI0..1PeriodRelevant time frame for the claim
... created SΣI1..1dateTimeResource creation date
... enterer I0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer ΣI0..1Reference(Organization)Target
... provider SΣI1..1Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization)Party responsible for the claim
... priority ΣI1..1CodeableConceptDesired processing ugency
Binding: ProcessPriorityCodes (example)
... fundsReserve I0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example)
... related I0..*BackboneElementPrior or corollary claims
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim I0..1Reference(Claim)Reference to the related claim
.... relationship I0..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example)
.... reference I0..1IdentifierFile or case reference
... prescription SI0..1Reference(QICoreDeviceRequest | QICoreMedicationRequest | VisionPrescription)Prescription authorizing services and products
... originalPrescription I0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee I0..1BackboneElementRecipient of benefits payable
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type I1..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example)
.... party I0..1Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization | QICorePatient | QICoreRelatedPerson)Recipient reference
... referral I0..1Reference(QICoreServiceRequest)Treatment referral
... facility I0..1Reference(QICoreLocation)Servicing facility
... careTeam I0..*BackboneElementMembers of the care team
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntOrder of care team
.... provider I1..1Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization)Practitioner or organization
.... responsible I0..1booleanIndicator of the lead practitioner
.... role I0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example)
.... qualification I0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo I0..*BackboneElementSupporting information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntInformation instance identifier
.... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
.... code I0..1CodeableConceptType of information
Binding: ExceptionCodes (example)
.... timing[x] I0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] I0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason I0..1CodeableConceptExplanation for the information
Binding: MissingToothReasonCodes (example)
... diagnosis I0..*BackboneElementPertinent diagnosis information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] I1..1Nature of illness or problem
Binding: ICD-10Codes (example)
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type I0..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example)
.... onAdmission I0..1CodeableConceptPresent on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example)
.... packageCode I0..1CodeableConceptPackage billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
... procedure I0..*BackboneElementClinical procedures performed
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntProcedure instance identifier
.... type I0..*CodeableConceptCategory of Procedure
Binding: ExampleProcedureTypeCodes (example)
.... date I0..1dateTimeWhen the procedure was performed
.... procedure[x] I1..1Specific clinical procedure
Binding: ICD-10ProcedureCodes (example)
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi I0..*Reference(Device)Unique device identifier
... insurance ΣI1..*BackboneElementPatient insurance information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence ΣI1..1positiveIntInsurance instance identifier
.... focal ΣI1..1booleanCoverage to be used for adjudication
.... identifier I0..1IdentifierPre-assigned Claim number
.... coverage ΣI1..1Reference(Coverage)Insurance information
.... businessArrangement I0..1stringAdditional provider contract number
.... preAuthRef I0..*stringPrior authorization reference number
.... claimResponse I0..1Reference(ClaimResponse)Adjudication results
... accident I0..1BackboneElementDetails of the event
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date I1..1dateWhen the incident occurred
.... type I0..1CodeableConceptThe nature of the accident
Binding: V3 Value SetActIncidentCode (extensible)
.... location[x] I0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item I0..*BackboneElementProduct or service provided
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntItem instance identifier
.... careTeamSequence I0..*positiveIntApplicable careTeam members
.... diagnosisSequence I0..*positiveIntApplicable diagnoses
.... procedureSequence I0..*positiveIntApplicable procedures
.... informationSequence I0..*positiveIntApplicable exception and supporting information
.... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
.... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
.... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
.... modifier I0..*CodeableConceptProduct or service billing modifiers
Binding: ModifierTypeCodes (example)
.... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
.... serviced[x] I0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] I0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity I0..1SimpleQuantityCount of products or services
.... unitPrice I0..1MoneyFee, charge or cost per item
.... factor I0..1decimalPrice scaling factor
.... net I0..1MoneyTotal item cost
.... udi I0..*Reference(Device)Unique device identifier
.... bodySite I0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example)
.... subSite I0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example)
.... encounter I0..*Reference(Encounter)Encounters related to this billed item
.... detail I0..*BackboneElementProduct or service provided
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntItem instance identifier
..... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
..... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
..... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
..... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
..... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
..... quantity I0..1SimpleQuantityCount of products or services
..... unitPrice I0..1MoneyFee, charge or cost per item
..... factor I0..1decimalPrice scaling factor
..... net I0..1MoneyTotal item cost
..... udi I0..*Reference(Device)Unique device identifier
..... subDetail I0..*BackboneElementProduct or service provided
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence I1..1positiveIntItem instance identifier
...... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
...... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
...... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
...... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
...... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
...... quantity I0..1SimpleQuantityCount of products or services
...... unitPrice I0..1MoneyFee, charge or cost per item
...... factor I0..1decimalPrice scaling factor
...... net I0..1MoneyTotal item cost
...... udi I0..*Reference(Device)Unique device identifier
... total I0..1MoneyTotal claim cost

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim I0..*ClaimClaim, Pre-determination or Pre-authorization
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier I0..*IdentifierBusiness Identifier for claim
... status ?!ΣI1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required)
... type ΣI1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (extensible)
... subType I0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example)
... use ΣI1..1codeclaim | preauthorization | predetermination
Binding: Use (required)
... patient SΣI1..1Reference(QICorePatient)The recipient of the products and services
... billablePeriod SΣI0..1PeriodRelevant time frame for the claim
... created SΣI1..1dateTimeResource creation date
... enterer I0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer ΣI0..1Reference(Organization)Target
... provider SΣI1..1Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization)Party responsible for the claim
... priority ΣI1..1CodeableConceptDesired processing ugency
Binding: ProcessPriorityCodes (example)
... fundsReserve I0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example)
... related I0..*BackboneElementPrior or corollary claims
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim I0..1Reference(Claim)Reference to the related claim
.... relationship I0..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example)
.... reference I0..1IdentifierFile or case reference
... prescription SI0..1Reference(QICoreDeviceRequest | QICoreMedicationRequest | VisionPrescription)Prescription authorizing services and products
... originalPrescription I0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee I0..1BackboneElementRecipient of benefits payable
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type I1..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example)
.... party I0..1Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization | QICorePatient | QICoreRelatedPerson)Recipient reference
... referral I0..1Reference(QICoreServiceRequest)Treatment referral
... facility I0..1Reference(QICoreLocation)Servicing facility
... careTeam I0..*BackboneElementMembers of the care team
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntOrder of care team
.... provider I1..1Reference(QICorePractitioner | QICorePractitionerRole | QICoreOrganization)Practitioner or organization
.... responsible I0..1booleanIndicator of the lead practitioner
.... role I0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example)
.... qualification I0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo I0..*BackboneElementSupporting information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntInformation instance identifier
.... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
.... code I0..1CodeableConceptType of information
Binding: ExceptionCodes (example)
.... timing[x] I0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] I0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason I0..1CodeableConceptExplanation for the information
Binding: MissingToothReasonCodes (example)
... diagnosis I0..*BackboneElementPertinent diagnosis information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] I1..1Nature of illness or problem
Binding: ICD-10Codes (example)
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type I0..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example)
.... onAdmission I0..1CodeableConceptPresent on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example)
.... packageCode I0..1CodeableConceptPackage billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
... procedure I0..*BackboneElementClinical procedures performed
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntProcedure instance identifier
.... type I0..*CodeableConceptCategory of Procedure
Binding: ExampleProcedureTypeCodes (example)
.... date I0..1dateTimeWhen the procedure was performed
.... procedure[x] I1..1Specific clinical procedure
Binding: ICD-10ProcedureCodes (example)
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi I0..*Reference(Device)Unique device identifier
... insurance ΣI1..*BackboneElementPatient insurance information
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence ΣI1..1positiveIntInsurance instance identifier
.... focal ΣI1..1booleanCoverage to be used for adjudication
.... identifier I0..1IdentifierPre-assigned Claim number
.... coverage ΣI1..1Reference(Coverage)Insurance information
.... businessArrangement I0..1stringAdditional provider contract number
.... preAuthRef I0..*stringPrior authorization reference number
.... claimResponse I0..1Reference(ClaimResponse)Adjudication results
... accident I0..1BackboneElementDetails of the event
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date I1..1dateWhen the incident occurred
.... type I0..1CodeableConceptThe nature of the accident
Binding: V3 Value SetActIncidentCode (extensible)
.... location[x] I0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item I0..*BackboneElementProduct or service provided
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntItem instance identifier
.... careTeamSequence I0..*positiveIntApplicable careTeam members
.... diagnosisSequence I0..*positiveIntApplicable diagnoses
.... procedureSequence I0..*positiveIntApplicable procedures
.... informationSequence I0..*positiveIntApplicable exception and supporting information
.... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
.... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
.... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
.... modifier I0..*CodeableConceptProduct or service billing modifiers
Binding: ModifierTypeCodes (example)
.... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
.... serviced[x] I0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] I0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity I0..1SimpleQuantityCount of products or services
.... unitPrice I0..1MoneyFee, charge or cost per item
.... factor I0..1decimalPrice scaling factor
.... net I0..1MoneyTotal item cost
.... udi I0..*Reference(Device)Unique device identifier
.... bodySite I0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example)
.... subSite I0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example)
.... encounter I0..*Reference(Encounter)Encounters related to this billed item
.... detail I0..*BackboneElementProduct or service provided
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntItem instance identifier
..... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
..... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
..... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
..... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
..... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
..... quantity I0..1SimpleQuantityCount of products or services
..... unitPrice I0..1MoneyFee, charge or cost per item
..... factor I0..1decimalPrice scaling factor
..... net I0..1MoneyTotal item cost
..... udi I0..*Reference(Device)Unique device identifier
..... subDetail I0..*BackboneElementProduct or service provided
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence I1..1positiveIntItem instance identifier
...... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
...... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
...... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
...... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
...... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
...... quantity I0..1SimpleQuantityCount of products or services
...... unitPrice I0..1MoneyFee, charge or cost per item
...... factor I0..1decimalPrice scaling factor
...... net I0..1MoneyTotal item cost
...... udi I0..*Reference(Device)Unique device identifier
... total I0..1MoneyTotal claim cost

doco Documentation for this format

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathConformanceValueSet
Claim.languagepreferredCommonLanguages
Max Binding: AllLanguages
Claim.statusrequiredFinancialResourceStatusCodes
Claim.typeextensibleClaimTypeCodes
Claim.subTypeexampleExampleClaimSubTypeCodes
Claim.userequiredUse
Claim.priorityexampleProcessPriorityCodes
Claim.fundsReserveexampleFunds Reservation Codes
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
Claim.payee.typeexampleClaim Payee Type Codes
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
Claim.supportingInfo.codeexampleExceptionCodes
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
Claim.procedure.typeexampleExampleProcedureTypeCodes
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
Claim.accident.typeextensiblev3.ActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
Claim.item.categoryexampleBenefitCategoryCodes
Claim.item.productOrServiceexampleUSCLSCodes
Claim.item.modifierexampleModifierTypeCodes
Claim.item.programCodeexampleExampleProgramReasonCodes
Claim.item.location[x]exampleExampleServicePlaceCodes
Claim.item.bodySiteexampleOralSiteCodes
Claim.item.subSiteexampleSurfaceCodes
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
Claim.item.detail.categoryexampleBenefitCategoryCodes
Claim.item.detail.productOrServiceexampleUSCLSCodes
Claim.item.detail.modifierexampleModifierTypeCodes
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2ClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3ClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4ClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5ClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6ClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1Claim.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.subTypeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.patientAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.billablePeriodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.createdAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.entererAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priorityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.fundsReserveAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.relatedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.related.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.related.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.related.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.related.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.related.claimAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.related.relationshipAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.related.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.prescriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.originalPrescriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.payeeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.payee.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.payee.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.payee.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.payee.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.payee.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.payee.partyAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.referralAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.facilityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeamAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.careTeam.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.careTeam.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.careTeam.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.careTeam.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.responsibleAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.roleAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.qualificationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfoAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.supportingInfo.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.supportingInfo.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.supportingInfo.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.supportingInfo.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.timing[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.reasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosisAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.diagnosis.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.diagnosis.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.diagnosis.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.diagnosis.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.diagnosis[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.onAdmissionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.packageCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedureAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.procedure.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.procedure.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.procedure.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.procedure.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.procedure[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insuranceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.insurance.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.insurance.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.insurance.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.insurance.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.focalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.coverageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.businessArrangementAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.preAuthRefAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.claimResponseAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accidentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accident.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.accident.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.accident.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.accident.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.accident.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accident.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accident.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.itemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.careTeamSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.diagnosisSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.procedureSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.informationSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.serviced[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.bodySiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.subSiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.encounterAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.subDetail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.subDetail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.subDetail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.subDetail.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.totalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())