QICoreClaim

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

= Must Support, = Is Modifier, = QiCore defined extension

Field	Card.	Type	Description
identifier	0..*	List<Identifier>	A unique identifier assigned to this claim.
status	1..1	String	The status of the resource instance. Binding: A code specifying the state of the resource instance. (required)
type	1..1	Concept	The category of claim, e.g. oral, pharmacy, vision, institutional, professional. Binding: The type or discipline-style of the claim. (extensible)
subType	0..1	Concept	A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. Binding: A more granular claim typecode. (example)
use	1..1	String	A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future. Binding: The purpose of the Claim: predetermination, preauthorization, claim. (required)
patient	1..1	QICorePatient	The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
billablePeriod	0..1	Interval<DateTime>	The period for which charges are being submitted.
created	1..1	DateTime	The date this resource was created.
enterer	0..1	QICorePractitioner | QICorePractitionerRole	Individual who created the claim, predetermination or preauthorization.
insurer	0..1	QICoreOrganization	The Insurer who is target of the request.
provider	1..1	QICorePractitioner | QICorePractitionerRole | QICoreOrganization	The provider which is responsible for the claim, predetermination or preauthorization.
priority	1..1	Concept	The provider-required urgency of processing the request. Typical values include: stat, routine deferred. Binding: The timeliness with which processing is required: stat, normal, deferred. (example)
fundsReserve	0..1	Concept	A code to indicate whether and for whom funds are to be reserved for future claims. Binding: For whom funds are to be reserved: (Patient, Provider, None). (example)
related	0..*	List<related>	Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescription	0..1	QICoreDeviceRequest | QICoreMedicationRequest | VisionPrescription	Prescription to support the dispensing of pharmacy, device or vision products.
originalPrescription	0..1	QICoreDeviceNotRequested | QICoreMedicationNotRequested | VisionPrescription	Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payee	0..1	payee	The party to be reimbursed for cost of the products and services according to the terms of the policy.
referral	0..1	QICoreServiceRequest	A reference to a referral resource.
facility	0..1	QICoreLocation	Facility where the services were provided.
careTeam	0..*	List<careTeam>	The members of the team who provided the products and services.
supportingInfo	0..*	List<supportingInfo>	Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosis	0..*	List<diagnosis>	Information about diagnoses relevant to the claim items.
procedure	0..*	List<procedure>	Procedures performed on the patient relevant to the billing items with the claim.
insurance	1..*	List<insurance>	Financial instruments for reimbursement for the health care products and services specified on the claim.
accident	0..1	accident	Details of an accident which resulted in injuries which required the products and services listed in the claim.
item	0..*	List<item>	A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
total	0..1	Money	The total value of the all the items in the claim.