Extensions for Using Data Elements from FHIR DSTU2 in FHIR R4B - Downloaded Version null See the Directory of published versions

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Resource Profile: Profile_R2_Claim_R4B

This cross-version profile allows DSTU2 Claim content to be represented via FHIR R4B Claim resources.

Usages:

• Refer to this Profile: DSTU2: Claim reference (new)

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(4.3.0)	Claim, Pre-determination or Pre-authorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:ruleset		0..1	Coding	DSTU2: Current specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.ruleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
extension:originalRuleset		0..1	Coding	DSTU2: Original specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
extension:organization		0..1	Reference(Cross-version Profile for DSTU2.Organization for use in FHIR R4B(0.1.0) | Organization)	DSTU2: Responsible organization (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.organization Constraints: ext-1
extension:condition		0..*	Coding	DSTU2: List of presenting Conditions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.condition Binding: R2FmConditionsForR4B (0.1.0) (example): Patient conditions and symptoms. Constraints: ext-1
extension:exception		0..*	Coding	DSTU2: Eligibility exceptions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.exception Binding: ExceptionCodes (example): The eligibility exception codes. Constraints: ext-1
extension:school		0..1	string	DSTU2: Name of School (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.school Constraints: ext-1
extension:interventionException		0..*	Coding	DSTU2: Intervention and exception code (Pharma) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.interventionException Binding: R2InterventionForR4B (0.1.0) (example): Intervention and exception codes (Pharm). Constraints: ext-1
extension:additionalMaterials		0..*	Coding	DSTU2: Additional materials, documents, etc. (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.additionalMaterials Binding: R2AdditionalmaterialsForR4B (0.1.0) (example): Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission. Constraints: ext-1
extension:missingTeeth		0..*	(Complex)	DSTU2: Only if type = oral (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.missingTeeth Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	code	DSTU2: institutional | oral | pharmacy | professional | vision URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.type Binding: ClaimTypeCodes (required): The type or discipline-style of the claim. Constraints: ext-1
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:use		0..1	code	DSTU2: complete | proposed | exploratory | other URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.use Binding: Use (required): Complete, proposed, exploratory, other. Constraints: ext-1
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:patient		0..1	Reference(Resource)	DSTU2: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
created	Σ	1..1	dateTime	Resource creation date
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:provider		0..1	Reference(Resource)	DSTU2: Responsible provider additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
insurance	Σ	1..*	BackboneElement	Patient insurance information
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:relationship		1..1	Coding	DSTU2: Patient relationship to subscriber (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.relationship Binding: Beneficiary Relationship Codes (example): The code for the relationship of the patient to the subscriber. Constraints: ext-1
extension:originalRuleset		0..1	Coding	DSTU2: Original version (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(Coverage)	Insurance information
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:coverage		0..1	Reference(Resource)	DSTU2: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
Claim.use	Base	required	Use	📍4.3.0	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	Claim.implicitRules, Claim.extension, Claim.extension:ruleset, Claim.extension:originalRuleset, Claim.extension:organization, Claim.extension:condition, Claim.extension:exception, Claim.extension:school, Claim.extension:interventionException, Claim.extension:additionalMaterials, Claim.extension:missingTeeth, Claim.modifierExtension, Claim.status, Claim.type, Claim.type.extension, Claim.type.extension:type, Claim.use, Claim.use.extension, Claim.use.extension:use, Claim.patient, Claim.patient.extension, Claim.patient.extension:patient, Claim.created, Claim.provider, Claim.provider.extension, Claim.provider.extension:provider, Claim.priority, Claim.insurance, Claim.insurance.extension, Claim.insurance.extension:relationship, Claim.insurance.extension:originalRuleset, Claim.insurance.modifierExtension, Claim.insurance.sequence, Claim.insurance.focal, Claim.insurance.coverage, Claim.insurance.coverage.extension, Claim.insurance.coverage.extension:coverage	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	Claim.extension, Claim.extension:ruleset, Claim.extension:originalRuleset, Claim.extension:organization, Claim.extension:condition, Claim.extension:exception, Claim.extension:school, Claim.extension:interventionException, Claim.extension:additionalMaterials, Claim.extension:missingTeeth, Claim.modifierExtension, Claim.type.extension, Claim.type.extension:type, Claim.use.extension, Claim.use.extension:use, Claim.patient.extension, Claim.patient.extension:patient, Claim.provider.extension, Claim.provider.extension:provider, Claim.insurance.extension, Claim.insurance.extension:relationship, Claim.insurance.extension:originalRuleset, Claim.insurance.modifierExtension, Claim.insurance.coverage.extension, Claim.insurance.coverage.extension:coverage	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(4.3.0)	Claim, Pre-determination or Pre-authorization
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	(Complex)	DSTU2: meta additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.meta
text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	(Complex)	DSTU2: text additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ruleset		0..1	Coding	DSTU2: Current specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.ruleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version.
extension:originalRuleset		0..1	Coding	DSTU2: Original specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version.
extension:organization		0..1	Reference(Cross-version Profile for DSTU2.Organization for use in FHIR R4B(0.1.0) | Organization)	DSTU2: Responsible organization (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.organization
extension:condition		0..*	Coding	DSTU2: List of presenting Conditions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.condition Binding: R2FmConditionsForR4B (0.1.0) (example): Patient conditions and symptoms.
extension:exception		0..*	Coding	DSTU2: Eligibility exceptions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.exception Binding: ExceptionCodes (example): The eligibility exception codes.
extension:school		0..1	string	DSTU2: Name of School (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.school
extension:interventionException		0..*	Coding	DSTU2: Intervention and exception code (Pharma) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.interventionException Binding: R2InterventionForR4B (0.1.0) (example): Intervention and exception codes (Pharm).
extension:additionalMaterials		0..*	Coding	DSTU2: Additional materials, documents, etc. (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.additionalMaterials Binding: R2AdditionalmaterialsForR4B (0.1.0) (example): Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission.
extension:missingTeeth		0..*	(Complex)	DSTU2: Only if type = oral (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.missingTeeth
identifier
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:identifier		0..*	Identifier	DSTU2: Claim number additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.identifier
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		0..1	code	DSTU2: institutional | oral | pharmacy | professional | vision URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.type Binding: ClaimTypeCodes (required): The type or discipline-style of the claim.
use
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:use		0..1	code	DSTU2: complete | proposed | exploratory | other URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.use Binding: Use (required): Complete, proposed, exploratory, other.
patient
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patient		0..1	Reference(Resource)	DSTU2: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
enterer
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:enterer		0..1	Reference(Resource)	DSTU2: Author additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
insurer
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:target		0..1	Reference(Resource)	DSTU2: Insurer additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
provider
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:provider		0..1	Reference(Resource)	DSTU2: Responsible provider additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
prescription
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:prescription		0..1	Reference(Resource)	DSTU2: Prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
originalPrescription
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:originalPrescription		0..1	Reference(Resource)	DSTU2: Original Prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
payee
party
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:provider		0..1	Reference(Resource)	DSTU2: Provider who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
extension:organization		0..1	Reference(Resource)	DSTU2: Organization who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
extension:person		0..1	Reference(Resource)	DSTU2: Other person who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
referral
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:referral		0..1	Reference(Resource)	DSTU2: Treatment Referral additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
facility
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:facility		0..1	Reference(Resource)	DSTU2: Servicing Facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
insurance
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:relationship		1..1	Coding	DSTU2: Patient relationship to subscriber (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.relationship Binding: Beneficiary Relationship Codes (example): The code for the relationship of the patient to the subscriber.
extension:originalRuleset		0..1	Coding	DSTU2: Original version (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version.
coverage
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:coverage		0..1	Reference(Resource)	DSTU2: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
claimResponse
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:claimResponse		0..1	Reference(Resource)	DSTU2: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
accident
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:accidentType		0..1	Coding	​DSTU2: Accident Type URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.accidentType Binding: http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|2.0.0 (required): Type of accident: work place, auto, etc.
item
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:provider		0..1	Reference(Cross-version Profile for DSTU2.Practitioner for use in FHIR R4B(0.1.0) | PractitionerRole)	DSTU2: Responsible practitioner (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.provider
extension:prosthesis		0..1	(Complex)	DSTU2: Prosthetic details (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.prosthesis
category
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		1..1	Coding	DSTU2: Group or type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc.
udi
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository.
detail
category
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		1..1	Coding	DSTU2: Group or type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc.
udi
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository.
subDetail
category
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		1..1	Coding	DSTU2: Type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc.
udi
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository.
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(4.3.0)	Claim, Pre-determination or Pre-authorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:meta		0..1	(Complex)	DSTU2: meta additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.meta Constraints: ext-1
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible)
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example)
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:text		0..1	(Complex)	DSTU2: text additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.text Constraints: ext-1
status		1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required)
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:ruleset		0..1	Coding	DSTU2: Current specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.ruleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
extension:originalRuleset		0..1	Coding	DSTU2: Original specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
extension:organization		0..1	Reference(Cross-version Profile for DSTU2.Organization for use in FHIR R4B(0.1.0) | Organization)	DSTU2: Responsible organization (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.organization Constraints: ext-1
extension:condition		0..*	Coding	DSTU2: List of presenting Conditions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.condition Binding: R2FmConditionsForR4B (0.1.0) (example): Patient conditions and symptoms. Constraints: ext-1
extension:exception		0..*	Coding	DSTU2: Eligibility exceptions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.exception Binding: ExceptionCodes (example): The eligibility exception codes. Constraints: ext-1
extension:school		0..1	string	DSTU2: Name of School (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.school Constraints: ext-1
extension:interventionException		0..*	Coding	DSTU2: Intervention and exception code (Pharma) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.interventionException Binding: R2InterventionForR4B (0.1.0) (example): Intervention and exception codes (Pharm). Constraints: ext-1
extension:additionalMaterials		0..*	Coding	DSTU2: Additional materials, documents, etc. (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.additionalMaterials Binding: R2AdditionalmaterialsForR4B (0.1.0) (example): Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission. Constraints: ext-1
extension:missingTeeth		0..*	(Complex)	DSTU2: Only if type = oral (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.missingTeeth Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier		0..*	Identifier	Business Identifier for claim
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:identifier		0..*	Identifier	DSTU2: Claim number additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.identifier Constraints: ext-1
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	code	DSTU2: institutional | oral | pharmacy | professional | vision URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.type Binding: ClaimTypeCodes (required): The type or discipline-style of the claim. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:use		0..1	code	DSTU2: complete | proposed | exploratory | other URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.use Binding: Use (required): Complete, proposed, exploratory, other. Constraints: ext-1
value		0..1	code	Primitive value for code
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:patient		0..1	Reference(Resource)	DSTU2: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Resource creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:enterer		0..1	Reference(Resource)	DSTU2: Author additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
insurer	Σ	0..1	Reference(Organization)	Target
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:target		0..1	Reference(Resource)	DSTU2: Insurer additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:provider		0..1	Reference(Resource)	DSTU2: Responsible provider additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
claim		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:prescription		0..1	Reference(Resource)	DSTU2: Prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:originalPrescription		0..1	Reference(Resource)	DSTU2: Original Prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
payee		0..1	BackboneElement	Recipient of benefits payable
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:provider		0..1	Reference(Resource)	DSTU2: Provider who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
extension:organization		0..1	Reference(Resource)	DSTU2: Organization who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
extension:person		0..1	Reference(Resource)	DSTU2: Other person who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
referral		0..1	Reference(ServiceRequest)	Treatment referral
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:referral		0..1	Reference(Resource)	DSTU2: Treatment Referral additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
facility		0..1	Reference(Location)	Servicing facility
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:facility		0..1	Reference(Resource)	DSTU2: Servicing Facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
careTeam		0..*	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis		0..*	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure		0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Procedure instance identifier
type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
insurance	Σ	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:relationship		1..1	Coding	DSTU2: Patient relationship to subscriber (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.relationship Binding: Beneficiary Relationship Codes (example): The code for the relationship of the patient to the subscriber. Constraints: ext-1
extension:originalRuleset		0..1	Coding	DSTU2: Original version (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	Σ	1..1	Reference(Coverage)	Insurance information
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:coverage		0..1	Reference(Resource)	DSTU2: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
businessArrangement		0..1	string	Additional provider contract number
preAuthRef		0..*	string	Prior authorization reference number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:claimResponse		0..1	Reference(Resource)	DSTU2: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
accident		0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
date		1..1	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:accidentType		0..1	Coding	​DSTU2: Accident Type URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.accidentType Binding: http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|2.0.0 (required): Type of accident: work place, auto, etc. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
item		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:provider		0..1	Reference(Cross-version Profile for DSTU2.Practitioner for use in FHIR R4B(0.1.0) | PractitionerRole)	DSTU2: Responsible practitioner (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.provider Constraints: ext-1
extension:prosthesis		0..1	(Complex)	DSTU2: Prosthetic details (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.prosthesis Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	Coding	DSTU2: Group or type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository. Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	Coding	DSTU2: Group or type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository. Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
subDetail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	Coding	DSTU2: Type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository. Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.security	Base	extensible	SecurityLabels	📍4.3.0	FHIR Std.
Claim.meta.tag	Base	example	Common Tags	📍4.3.0	FHIR Std.
Claim.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
Claim.text.status	Base	required	NarrativeStatus	📍4.3.0	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.3.0	FHIR Std.
Claim.identifier.type	Base	extensible	IdentifierType	📍4.3.0	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
Claim.subType	Base	example	Example Claim SubType Codes	📍4.3.0	FHIR Std.
Claim.use	Base	required	Use	📍4.3.0	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.enterer.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.insurer.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.provider.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.3.0	FHIR Std.
Claim.fundsReserve	Base	example	FundsReserve	📍4.3.0	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.3.0	FHIR Std.
Claim.prescription.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.originalPrescription.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.3.0	FHIR Std.
Claim.payee.party.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.referral.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.facility.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.3.0	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.3.0	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.3.0	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.3.0	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.3.0	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.3.0	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.3.0	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.3.0	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.3.0	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.3.0	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.3.0	FHIR Std.
Claim.insurance.coverage.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.insurance.claimResponse.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📍3.0.0	THO v7.1
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍4.3.0	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍4.3.0	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
Claim.item.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.3.0	FHIR Std.
Claim.item.udi.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.3.0	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.3.0	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.3.0	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.3.0	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
Claim.item.detail.udi.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​udi.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
dom-r4b	warning	Claim.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems	($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
ele-1	error	Claim.meta, Claim.meta.extension, Claim.meta.extension:meta, Claim.meta.versionId, Claim.meta.lastUpdated, Claim.meta.source, Claim.meta.profile, Claim.meta.security, Claim.meta.tag, Claim.implicitRules, Claim.language, Claim.text, Claim.text.extension, Claim.text.extension:text, Claim.text.status, Claim.text.div, Claim.extension, Claim.extension:ruleset, Claim.extension:originalRuleset, Claim.extension:organization, Claim.extension:condition, Claim.extension:exception, Claim.extension:school, Claim.extension:interventionException, Claim.extension:additionalMaterials, Claim.extension:missingTeeth, Claim.modifierExtension, Claim.identifier, Claim.identifier.extension, Claim.identifier.extension:identifier, Claim.identifier.use, Claim.identifier.type, Claim.identifier.system, Claim.identifier.value, Claim.identifier.period, Claim.identifier.assigner, Claim.status, Claim.type, Claim.type.extension, Claim.type.extension:type, Claim.type.coding, Claim.type.text, Claim.subType, Claim.use, Claim.use.extension, Claim.use.extension:use, Claim.patient, Claim.patient.extension, Claim.patient.extension:patient, Claim.patient.reference, Claim.patient.type, Claim.patient.identifier, Claim.patient.display, Claim.billablePeriod, Claim.created, Claim.enterer, Claim.enterer.extension, Claim.enterer.extension:enterer, Claim.enterer.reference, Claim.enterer.type, Claim.enterer.identifier, Claim.enterer.display, Claim.insurer, Claim.insurer.extension, Claim.insurer.extension:target, Claim.insurer.reference, Claim.insurer.type, Claim.insurer.identifier, Claim.insurer.display, Claim.provider, Claim.provider.extension, Claim.provider.extension:provider, Claim.provider.reference, Claim.provider.type, Claim.provider.identifier, Claim.provider.display, Claim.priority, Claim.fundsReserve, Claim.related, Claim.related.extension, Claim.related.modifierExtension, Claim.related.claim, Claim.related.relationship, Claim.related.reference, Claim.prescription, Claim.prescription.extension, Claim.prescription.extension:prescription, Claim.prescription.reference, Claim.prescription.type, Claim.prescription.identifier, Claim.prescription.display, Claim.originalPrescription, Claim.originalPrescription.extension, Claim.originalPrescription.extension:originalPrescription, Claim.originalPrescription.reference, Claim.originalPrescription.type, Claim.originalPrescription.identifier, Claim.originalPrescription.display, Claim.payee, Claim.payee.extension, Claim.payee.modifierExtension, Claim.payee.type, Claim.payee.party, Claim.payee.party.extension, Claim.payee.party.extension:provider, Claim.payee.party.extension:organization, Claim.payee.party.extension:person, Claim.payee.party.reference, Claim.payee.party.type, Claim.payee.party.identifier, Claim.payee.party.display, Claim.referral, Claim.referral.extension, Claim.referral.extension:referral, Claim.referral.reference, Claim.referral.type, Claim.referral.identifier, Claim.referral.display, Claim.facility, Claim.facility.extension, Claim.facility.extension:facility, Claim.facility.reference, Claim.facility.type, Claim.facility.identifier, Claim.facility.display, Claim.careTeam, Claim.careTeam.extension, Claim.careTeam.modifierExtension, Claim.careTeam.sequence, Claim.careTeam.provider, Claim.careTeam.responsible, Claim.careTeam.role, Claim.careTeam.qualification, Claim.supportingInfo, Claim.supportingInfo.extension, Claim.supportingInfo.modifierExtension, Claim.supportingInfo.sequence, Claim.supportingInfo.category, Claim.supportingInfo.code, Claim.supportingInfo.timing[x], Claim.supportingInfo.value[x], Claim.supportingInfo.reason, Claim.diagnosis, Claim.diagnosis.extension, Claim.diagnosis.modifierExtension, Claim.diagnosis.sequence, Claim.diagnosis.diagnosis[x], Claim.diagnosis.type, Claim.diagnosis.onAdmission, Claim.diagnosis.packageCode, Claim.procedure, Claim.procedure.extension, Claim.procedure.modifierExtension, Claim.procedure.sequence, Claim.procedure.type, Claim.procedure.date, Claim.procedure.procedure[x], Claim.procedure.udi, Claim.insurance, Claim.insurance.extension, Claim.insurance.extension:relationship, Claim.insurance.extension:originalRuleset, Claim.insurance.modifierExtension, Claim.insurance.sequence, Claim.insurance.focal, Claim.insurance.identifier, Claim.insurance.coverage, Claim.insurance.coverage.extension, Claim.insurance.coverage.extension:coverage, Claim.insurance.coverage.reference, Claim.insurance.coverage.type, Claim.insurance.coverage.identifier, Claim.insurance.coverage.display, Claim.insurance.businessArrangement, Claim.insurance.preAuthRef, Claim.insurance.claimResponse, Claim.insurance.claimResponse.extension, Claim.insurance.claimResponse.extension:claimResponse, Claim.insurance.claimResponse.reference, Claim.insurance.claimResponse.type, Claim.insurance.claimResponse.identifier, Claim.insurance.claimResponse.display, Claim.accident, Claim.accident.extension, Claim.accident.modifierExtension, Claim.accident.date, Claim.accident.type, Claim.accident.type.extension, Claim.accident.type.extension:accidentType, Claim.accident.type.coding, Claim.accident.type.text, Claim.accident.location[x], Claim.item, Claim.item.extension, Claim.item.extension:provider, Claim.item.extension:prosthesis, Claim.item.modifierExtension, Claim.item.sequence, Claim.item.careTeamSequence, Claim.item.diagnosisSequence, Claim.item.procedureSequence, Claim.item.informationSequence, Claim.item.revenue, Claim.item.category, Claim.item.category.extension, Claim.item.category.extension:type, Claim.item.category.coding, Claim.item.category.text, Claim.item.productOrService, Claim.item.modifier, Claim.item.programCode, Claim.item.serviced[x], Claim.item.location[x], Claim.item.quantity, Claim.item.unitPrice, Claim.item.factor, Claim.item.net, Claim.item.udi, Claim.item.udi.extension, Claim.item.udi.extension:udi, Claim.item.udi.reference, Claim.item.udi.type, Claim.item.udi.identifier, Claim.item.udi.display, Claim.item.bodySite, Claim.item.subSite, Claim.item.encounter, Claim.item.detail, Claim.item.detail.extension, Claim.item.detail.modifierExtension, Claim.item.detail.sequence, Claim.item.detail.revenue, Claim.item.detail.category, Claim.item.detail.category.extension, Claim.item.detail.category.extension:type, Claim.item.detail.category.coding, Claim.item.detail.category.text, Claim.item.detail.productOrService, Claim.item.detail.modifier, Claim.item.detail.programCode, Claim.item.detail.quantity, Claim.item.detail.unitPrice, Claim.item.detail.factor, Claim.item.detail.net, Claim.item.detail.udi, Claim.item.detail.udi.extension, Claim.item.detail.udi.extension:udi, Claim.item.detail.udi.reference, Claim.item.detail.udi.type, Claim.item.detail.udi.identifier, Claim.item.detail.udi.display, Claim.item.detail.subDetail, Claim.item.detail.subDetail.extension, Claim.item.detail.subDetail.modifierExtension, Claim.item.detail.subDetail.sequence, Claim.item.detail.subDetail.revenue, Claim.item.detail.subDetail.category, Claim.item.detail.subDetail.category.extension, Claim.item.detail.subDetail.category.extension:type, Claim.item.detail.subDetail.category.coding, Claim.item.detail.subDetail.category.text, Claim.item.detail.subDetail.productOrService, Claim.item.detail.subDetail.modifier, Claim.item.detail.subDetail.programCode, Claim.item.detail.subDetail.quantity, Claim.item.detail.subDetail.unitPrice, Claim.item.detail.subDetail.factor, Claim.item.detail.subDetail.net, Claim.item.detail.subDetail.udi, Claim.item.detail.subDetail.udi.extension, Claim.item.detail.subDetail.udi.extension:udi, Claim.item.detail.subDetail.udi.reference, Claim.item.detail.subDetail.udi.type, Claim.item.detail.subDetail.udi.identifier, Claim.item.detail.subDetail.udi.display, Claim.total	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	Claim.meta.extension, Claim.meta.extension:meta, Claim.text.extension, Claim.text.extension:text, Claim.extension, Claim.extension:ruleset, Claim.extension:originalRuleset, Claim.extension:organization, Claim.extension:condition, Claim.extension:exception, Claim.extension:school, Claim.extension:interventionException, Claim.extension:additionalMaterials, Claim.extension:missingTeeth, Claim.modifierExtension, Claim.identifier.extension, Claim.identifier.extension:identifier, Claim.type.extension, Claim.type.extension:type, Claim.use.extension, Claim.use.extension:use, Claim.patient.extension, Claim.patient.extension:patient, Claim.enterer.extension, Claim.enterer.extension:enterer, Claim.insurer.extension, Claim.insurer.extension:target, Claim.provider.extension, Claim.provider.extension:provider, Claim.related.extension, Claim.related.modifierExtension, Claim.prescription.extension, Claim.prescription.extension:prescription, Claim.originalPrescription.extension, Claim.originalPrescription.extension:originalPrescription, Claim.payee.extension, Claim.payee.modifierExtension, Claim.payee.party.extension, Claim.payee.party.extension:provider, Claim.payee.party.extension:organization, Claim.payee.party.extension:person, Claim.referral.extension, Claim.referral.extension:referral, Claim.facility.extension, Claim.facility.extension:facility, Claim.careTeam.extension, Claim.careTeam.modifierExtension, Claim.supportingInfo.extension, Claim.supportingInfo.modifierExtension, Claim.diagnosis.extension, Claim.diagnosis.modifierExtension, Claim.procedure.extension, Claim.procedure.modifierExtension, Claim.insurance.extension, Claim.insurance.extension:relationship, Claim.insurance.extension:originalRuleset, Claim.insurance.modifierExtension, Claim.insurance.coverage.extension, Claim.insurance.coverage.extension:coverage, Claim.insurance.claimResponse.extension, Claim.insurance.claimResponse.extension:claimResponse, Claim.accident.extension, Claim.accident.modifierExtension, Claim.accident.type.extension, Claim.accident.type.extension:accidentType, Claim.item.extension, Claim.item.extension:provider, Claim.item.extension:prosthesis, Claim.item.modifierExtension, Claim.item.category.extension, Claim.item.category.extension:type, Claim.item.udi.extension, Claim.item.udi.extension:udi, Claim.item.detail.extension, Claim.item.detail.modifierExtension, Claim.item.detail.category.extension, Claim.item.detail.category.extension:type, Claim.item.detail.udi.extension, Claim.item.detail.udi.extension:udi, Claim.item.detail.subDetail.extension, Claim.item.detail.subDetail.modifierExtension, Claim.item.detail.subDetail.category.extension, Claim.item.detail.subDetail.category.extension:type, Claim.item.detail.subDetail.udi.extension, Claim.item.detail.subDetail.udi.extension:udi	Must have either extensions or value[x], not both	extension.exists() != value.exists()
txt-1	error	Claim.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	Claim.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

This structure is derived from Claim

Summary

Mandatory: 2 elements(6 nested mandatory elements)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.meta|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.text|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.ruleset|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.originalRuleset|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.organization|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.condition|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.exception|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.school|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.interventionException|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.additionalMaterials|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.missingTeeth|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.identifier|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.type|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.use|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.relationship|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.originalRuleset|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.accidentType|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.provider|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.prosthesis|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.type|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.udi|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.type|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.udi|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.type|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.udi|0.1.0

Maturity: 0

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(4.3.0)	Claim, Pre-determination or Pre-authorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:ruleset		0..1	Coding	DSTU2: Current specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.ruleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
extension:originalRuleset		0..1	Coding	DSTU2: Original specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
extension:organization		0..1	Reference(Cross-version Profile for DSTU2.Organization for use in FHIR R4B(0.1.0) | Organization)	DSTU2: Responsible organization (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.organization Constraints: ext-1
extension:condition		0..*	Coding	DSTU2: List of presenting Conditions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.condition Binding: R2FmConditionsForR4B (0.1.0) (example): Patient conditions and symptoms. Constraints: ext-1
extension:exception		0..*	Coding	DSTU2: Eligibility exceptions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.exception Binding: ExceptionCodes (example): The eligibility exception codes. Constraints: ext-1
extension:school		0..1	string	DSTU2: Name of School (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.school Constraints: ext-1
extension:interventionException		0..*	Coding	DSTU2: Intervention and exception code (Pharma) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.interventionException Binding: R2InterventionForR4B (0.1.0) (example): Intervention and exception codes (Pharm). Constraints: ext-1
extension:additionalMaterials		0..*	Coding	DSTU2: Additional materials, documents, etc. (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.additionalMaterials Binding: R2AdditionalmaterialsForR4B (0.1.0) (example): Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission. Constraints: ext-1
extension:missingTeeth		0..*	(Complex)	DSTU2: Only if type = oral (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.missingTeeth Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	code	DSTU2: institutional | oral | pharmacy | professional | vision URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.type Binding: ClaimTypeCodes (required): The type or discipline-style of the claim. Constraints: ext-1
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:use		0..1	code	DSTU2: complete | proposed | exploratory | other URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.use Binding: Use (required): Complete, proposed, exploratory, other. Constraints: ext-1
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:patient		0..1	Reference(Resource)	DSTU2: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
created	Σ	1..1	dateTime	Resource creation date
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:provider		0..1	Reference(Resource)	DSTU2: Responsible provider additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
insurance	Σ	1..*	BackboneElement	Patient insurance information
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:relationship		1..1	Coding	DSTU2: Patient relationship to subscriber (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.relationship Binding: Beneficiary Relationship Codes (example): The code for the relationship of the patient to the subscriber. Constraints: ext-1
extension:originalRuleset		0..1	Coding	DSTU2: Original version (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(Coverage)	Insurance information
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:coverage		0..1	Reference(Resource)	DSTU2: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
Claim.use	Base	required	Use	📍4.3.0	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	Claim.implicitRules, Claim.extension, Claim.extension:ruleset, Claim.extension:originalRuleset, Claim.extension:organization, Claim.extension:condition, Claim.extension:exception, Claim.extension:school, Claim.extension:interventionException, Claim.extension:additionalMaterials, Claim.extension:missingTeeth, Claim.modifierExtension, Claim.status, Claim.type, Claim.type.extension, Claim.type.extension:type, Claim.use, Claim.use.extension, Claim.use.extension:use, Claim.patient, Claim.patient.extension, Claim.patient.extension:patient, Claim.created, Claim.provider, Claim.provider.extension, Claim.provider.extension:provider, Claim.priority, Claim.insurance, Claim.insurance.extension, Claim.insurance.extension:relationship, Claim.insurance.extension:originalRuleset, Claim.insurance.modifierExtension, Claim.insurance.sequence, Claim.insurance.focal, Claim.insurance.coverage, Claim.insurance.coverage.extension, Claim.insurance.coverage.extension:coverage	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	Claim.extension, Claim.extension:ruleset, Claim.extension:originalRuleset, Claim.extension:organization, Claim.extension:condition, Claim.extension:exception, Claim.extension:school, Claim.extension:interventionException, Claim.extension:additionalMaterials, Claim.extension:missingTeeth, Claim.modifierExtension, Claim.type.extension, Claim.type.extension:type, Claim.use.extension, Claim.use.extension:use, Claim.patient.extension, Claim.patient.extension:patient, Claim.provider.extension, Claim.provider.extension:provider, Claim.insurance.extension, Claim.insurance.extension:relationship, Claim.insurance.extension:originalRuleset, Claim.insurance.modifierExtension, Claim.insurance.coverage.extension, Claim.insurance.coverage.extension:coverage	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(4.3.0)	Claim, Pre-determination or Pre-authorization
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	(Complex)	DSTU2: meta additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.meta
text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	(Complex)	DSTU2: text additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ruleset		0..1	Coding	DSTU2: Current specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.ruleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version.
extension:originalRuleset		0..1	Coding	DSTU2: Original specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version.
extension:organization		0..1	Reference(Cross-version Profile for DSTU2.Organization for use in FHIR R4B(0.1.0) | Organization)	DSTU2: Responsible organization (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.organization
extension:condition		0..*	Coding	DSTU2: List of presenting Conditions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.condition Binding: R2FmConditionsForR4B (0.1.0) (example): Patient conditions and symptoms.
extension:exception		0..*	Coding	DSTU2: Eligibility exceptions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.exception Binding: ExceptionCodes (example): The eligibility exception codes.
extension:school		0..1	string	DSTU2: Name of School (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.school
extension:interventionException		0..*	Coding	DSTU2: Intervention and exception code (Pharma) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.interventionException Binding: R2InterventionForR4B (0.1.0) (example): Intervention and exception codes (Pharm).
extension:additionalMaterials		0..*	Coding	DSTU2: Additional materials, documents, etc. (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.additionalMaterials Binding: R2AdditionalmaterialsForR4B (0.1.0) (example): Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission.
extension:missingTeeth		0..*	(Complex)	DSTU2: Only if type = oral (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.missingTeeth
identifier
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:identifier		0..*	Identifier	DSTU2: Claim number additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.identifier
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		0..1	code	DSTU2: institutional | oral | pharmacy | professional | vision URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.type Binding: ClaimTypeCodes (required): The type or discipline-style of the claim.
use
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:use		0..1	code	DSTU2: complete | proposed | exploratory | other URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.use Binding: Use (required): Complete, proposed, exploratory, other.
patient
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patient		0..1	Reference(Resource)	DSTU2: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
enterer
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:enterer		0..1	Reference(Resource)	DSTU2: Author additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
insurer
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:target		0..1	Reference(Resource)	DSTU2: Insurer additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
provider
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:provider		0..1	Reference(Resource)	DSTU2: Responsible provider additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
prescription
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:prescription		0..1	Reference(Resource)	DSTU2: Prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
originalPrescription
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:originalPrescription		0..1	Reference(Resource)	DSTU2: Original Prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
payee
party
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:provider		0..1	Reference(Resource)	DSTU2: Provider who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
extension:organization		0..1	Reference(Resource)	DSTU2: Organization who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
extension:person		0..1	Reference(Resource)	DSTU2: Other person who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
referral
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:referral		0..1	Reference(Resource)	DSTU2: Treatment Referral additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
facility
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:facility		0..1	Reference(Resource)	DSTU2: Servicing Facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
insurance
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:relationship		1..1	Coding	DSTU2: Patient relationship to subscriber (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.relationship Binding: Beneficiary Relationship Codes (example): The code for the relationship of the patient to the subscriber.
extension:originalRuleset		0..1	Coding	DSTU2: Original version (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version.
coverage
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:coverage		0..1	Reference(Resource)	DSTU2: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
claimResponse
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:claimResponse		0..1	Reference(Resource)	DSTU2: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
accident
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:accidentType		0..1	Coding	​DSTU2: Accident Type URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.accidentType Binding: http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|2.0.0 (required): Type of accident: work place, auto, etc.
item
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:provider		0..1	Reference(Cross-version Profile for DSTU2.Practitioner for use in FHIR R4B(0.1.0) | PractitionerRole)	DSTU2: Responsible practitioner (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.provider
extension:prosthesis		0..1	(Complex)	DSTU2: Prosthetic details (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.prosthesis
category
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		1..1	Coding	DSTU2: Group or type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc.
udi
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository.
detail
category
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		1..1	Coding	DSTU2: Group or type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc.
udi
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository.
subDetail
category
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		1..1	Coding	DSTU2: Type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc.
udi
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository.
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim(4.3.0)	Claim, Pre-determination or Pre-authorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:meta		0..1	(Complex)	DSTU2: meta additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.meta Constraints: ext-1
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible)
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example)
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:text		0..1	(Complex)	DSTU2: text additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.text Constraints: ext-1
status		1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required)
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:ruleset		0..1	Coding	DSTU2: Current specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.ruleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
extension:originalRuleset		0..1	Coding	DSTU2: Original specification followed (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
extension:organization		0..1	Reference(Cross-version Profile for DSTU2.Organization for use in FHIR R4B(0.1.0) | Organization)	DSTU2: Responsible organization (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.organization Constraints: ext-1
extension:condition		0..*	Coding	DSTU2: List of presenting Conditions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.condition Binding: R2FmConditionsForR4B (0.1.0) (example): Patient conditions and symptoms. Constraints: ext-1
extension:exception		0..*	Coding	DSTU2: Eligibility exceptions (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.exception Binding: ExceptionCodes (example): The eligibility exception codes. Constraints: ext-1
extension:school		0..1	string	DSTU2: Name of School (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.school Constraints: ext-1
extension:interventionException		0..*	Coding	DSTU2: Intervention and exception code (Pharma) (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.interventionException Binding: R2InterventionForR4B (0.1.0) (example): Intervention and exception codes (Pharm). Constraints: ext-1
extension:additionalMaterials		0..*	Coding	DSTU2: Additional materials, documents, etc. (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.additionalMaterials Binding: R2AdditionalmaterialsForR4B (0.1.0) (example): Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission. Constraints: ext-1
extension:missingTeeth		0..*	(Complex)	DSTU2: Only if type = oral (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.missingTeeth Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier		0..*	Identifier	Business Identifier for claim
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:identifier		0..*	Identifier	DSTU2: Claim number additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.identifier Constraints: ext-1
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	code	DSTU2: institutional | oral | pharmacy | professional | vision URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.type Binding: ClaimTypeCodes (required): The type or discipline-style of the claim. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:use		0..1	code	DSTU2: complete | proposed | exploratory | other URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.use Binding: Use (required): Complete, proposed, exploratory, other. Constraints: ext-1
value		0..1	code	Primitive value for code
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:patient		0..1	Reference(Resource)	DSTU2: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Resource creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:enterer		0..1	Reference(Resource)	DSTU2: Author additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
insurer	Σ	0..1	Reference(Organization)	Target
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:target		0..1	Reference(Resource)	DSTU2: Insurer additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:provider		0..1	Reference(Resource)	DSTU2: Responsible provider additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
claim		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:prescription		0..1	Reference(Resource)	DSTU2: Prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:originalPrescription		0..1	Reference(Resource)	DSTU2: Original Prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
payee		0..1	BackboneElement	Recipient of benefits payable
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:provider		0..1	Reference(Resource)	DSTU2: Provider who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
extension:organization		0..1	Reference(Resource)	DSTU2: Organization who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
extension:person		0..1	Reference(Resource)	DSTU2: Other person who is the payee additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
referral		0..1	Reference(ServiceRequest)	Treatment referral
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:referral		0..1	Reference(Resource)	DSTU2: Treatment Referral additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
facility		0..1	Reference(Location)	Servicing facility
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:facility		0..1	Reference(Resource)	DSTU2: Servicing Facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
careTeam		0..*	BackboneElement	Members of the care team
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis		0..*	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure		0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Procedure instance identifier
type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
insurance	Σ	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:relationship		1..1	Coding	DSTU2: Patient relationship to subscriber (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.relationship Binding: Beneficiary Relationship Codes (example): The code for the relationship of the patient to the subscriber. Constraints: ext-1
extension:originalRuleset		0..1	Coding	DSTU2: Original version (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.originalRuleset Binding: R2RulesetForR4B (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version. Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
identifier		0..1	Identifier	Pre-assigned Claim number
coverage	Σ	1..1	Reference(Coverage)	Insurance information
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:coverage		0..1	Reference(Resource)	DSTU2: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
businessArrangement		0..1	string	Additional provider contract number
preAuthRef		0..*	string	Prior authorization reference number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:claimResponse		0..1	Reference(Resource)	DSTU2: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
accident		0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
date		1..1	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:accidentType		0..1	Coding	​DSTU2: Accident Type URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.accidentType Binding: http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|2.0.0 (required): Type of accident: work place, auto, etc. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
item		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:provider		0..1	Reference(Cross-version Profile for DSTU2.Practitioner for use in FHIR R4B(0.1.0) | PractitionerRole)	DSTU2: Responsible practitioner (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.provider Constraints: ext-1
extension:prosthesis		0..1	(Complex)	DSTU2: Prosthetic details (new) URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.prosthesis Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	Coding	DSTU2: Group or type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository. Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	Coding	DSTU2: Group or type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository. Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
subDetail		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
id		0..1	id	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		1..1	Coding	DSTU2: Type of product or service URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.type Binding: R2V3ActInvoiceGroupCodeForR4B (0.1.0) (required): Service, Product, Rx Dispense, Rx Compound etc. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:udi		0..1	Coding	DSTU2: Unique Device Identifier additional types URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.udi Binding: R2UdiForR4B (0.1.0) (example): The FDA, or other, UDI repository. Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.security	Base	extensible	SecurityLabels	📍4.3.0	FHIR Std.
Claim.meta.tag	Base	example	Common Tags	📍4.3.0	FHIR Std.
Claim.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
Claim.text.status	Base	required	NarrativeStatus	📍4.3.0	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.3.0	FHIR Std.
Claim.identifier.type	Base	extensible	IdentifierType	📍4.3.0	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
Claim.subType	Base	example	Example Claim SubType Codes	📍4.3.0	FHIR Std.
Claim.use	Base	required	Use	📍4.3.0	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.enterer.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.insurer.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.provider.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.3.0	FHIR Std.
Claim.fundsReserve	Base	example	FundsReserve	📍4.3.0	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.3.0	FHIR Std.
Claim.prescription.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.originalPrescription.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.3.0	FHIR Std.
Claim.payee.party.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.referral.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.facility.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.3.0	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.3.0	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.3.0	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.3.0	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.3.0	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.3.0	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.3.0	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.3.0	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.3.0	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.3.0	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.3.0	FHIR Std.
Claim.insurance.coverage.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.insurance.claimResponse.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📍3.0.0	THO v7.1
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍4.3.0	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍4.3.0	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
Claim.item.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.3.0	FHIR Std.
Claim.item.udi.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.3.0	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.3.0	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.3.0	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.3.0	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
Claim.item.detail.udi.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
Claim.item.detail.subDetail.​udi.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
dom-r4b	warning	Claim.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems	($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
ele-1	error	Claim.meta, Claim.meta.extension, Claim.meta.extension:meta, Claim.meta.versionId, Claim.meta.lastUpdated, Claim.meta.source, Claim.meta.profile, Claim.meta.security, Claim.meta.tag, Claim.implicitRules, Claim.language, Claim.text, Claim.text.extension, Claim.text.extension:text, Claim.text.status, Claim.text.div, Claim.extension, Claim.extension:ruleset, Claim.extension:originalRuleset, Claim.extension:organization, Claim.extension:condition, Claim.extension:exception, Claim.extension:school, Claim.extension:interventionException, Claim.extension:additionalMaterials, Claim.extension:missingTeeth, Claim.modifierExtension, Claim.identifier, Claim.identifier.extension, Claim.identifier.extension:identifier, Claim.identifier.use, Claim.identifier.type, Claim.identifier.system, Claim.identifier.value, Claim.identifier.period, Claim.identifier.assigner, Claim.status, Claim.type, Claim.type.extension, Claim.type.extension:type, Claim.type.coding, Claim.type.text, Claim.subType, Claim.use, Claim.use.extension, Claim.use.extension:use, Claim.patient, Claim.patient.extension, Claim.patient.extension:patient, Claim.patient.reference, Claim.patient.type, Claim.patient.identifier, Claim.patient.display, Claim.billablePeriod, Claim.created, Claim.enterer, Claim.enterer.extension, Claim.enterer.extension:enterer, Claim.enterer.reference, Claim.enterer.type, Claim.enterer.identifier, Claim.enterer.display, Claim.insurer, Claim.insurer.extension, Claim.insurer.extension:target, Claim.insurer.reference, Claim.insurer.type, Claim.insurer.identifier, Claim.insurer.display, Claim.provider, Claim.provider.extension, Claim.provider.extension:provider, Claim.provider.reference, Claim.provider.type, Claim.provider.identifier, Claim.provider.display, Claim.priority, Claim.fundsReserve, Claim.related, Claim.related.extension, Claim.related.modifierExtension, Claim.related.claim, Claim.related.relationship, Claim.related.reference, Claim.prescription, Claim.prescription.extension, Claim.prescription.extension:prescription, Claim.prescription.reference, Claim.prescription.type, Claim.prescription.identifier, Claim.prescription.display, Claim.originalPrescription, Claim.originalPrescription.extension, Claim.originalPrescription.extension:originalPrescription, Claim.originalPrescription.reference, Claim.originalPrescription.type, Claim.originalPrescription.identifier, Claim.originalPrescription.display, Claim.payee, Claim.payee.extension, Claim.payee.modifierExtension, Claim.payee.type, Claim.payee.party, Claim.payee.party.extension, Claim.payee.party.extension:provider, Claim.payee.party.extension:organization, Claim.payee.party.extension:person, Claim.payee.party.reference, Claim.payee.party.type, Claim.payee.party.identifier, Claim.payee.party.display, Claim.referral, Claim.referral.extension, Claim.referral.extension:referral, Claim.referral.reference, Claim.referral.type, Claim.referral.identifier, Claim.referral.display, Claim.facility, Claim.facility.extension, Claim.facility.extension:facility, Claim.facility.reference, Claim.facility.type, Claim.facility.identifier, Claim.facility.display, Claim.careTeam, Claim.careTeam.extension, Claim.careTeam.modifierExtension, Claim.careTeam.sequence, Claim.careTeam.provider, Claim.careTeam.responsible, Claim.careTeam.role, Claim.careTeam.qualification, Claim.supportingInfo, Claim.supportingInfo.extension, Claim.supportingInfo.modifierExtension, Claim.supportingInfo.sequence, Claim.supportingInfo.category, Claim.supportingInfo.code, Claim.supportingInfo.timing[x], Claim.supportingInfo.value[x], Claim.supportingInfo.reason, Claim.diagnosis, Claim.diagnosis.extension, Claim.diagnosis.modifierExtension, Claim.diagnosis.sequence, Claim.diagnosis.diagnosis[x], Claim.diagnosis.type, Claim.diagnosis.onAdmission, Claim.diagnosis.packageCode, Claim.procedure, Claim.procedure.extension, Claim.procedure.modifierExtension, Claim.procedure.sequence, Claim.procedure.type, Claim.procedure.date, Claim.procedure.procedure[x], Claim.procedure.udi, Claim.insurance, Claim.insurance.extension, Claim.insurance.extension:relationship, Claim.insurance.extension:originalRuleset, Claim.insurance.modifierExtension, Claim.insurance.sequence, Claim.insurance.focal, Claim.insurance.identifier, Claim.insurance.coverage, Claim.insurance.coverage.extension, Claim.insurance.coverage.extension:coverage, Claim.insurance.coverage.reference, Claim.insurance.coverage.type, Claim.insurance.coverage.identifier, Claim.insurance.coverage.display, Claim.insurance.businessArrangement, Claim.insurance.preAuthRef, Claim.insurance.claimResponse, Claim.insurance.claimResponse.extension, Claim.insurance.claimResponse.extension:claimResponse, Claim.insurance.claimResponse.reference, Claim.insurance.claimResponse.type, Claim.insurance.claimResponse.identifier, Claim.insurance.claimResponse.display, Claim.accident, Claim.accident.extension, Claim.accident.modifierExtension, Claim.accident.date, Claim.accident.type, Claim.accident.type.extension, Claim.accident.type.extension:accidentType, Claim.accident.type.coding, Claim.accident.type.text, Claim.accident.location[x], Claim.item, Claim.item.extension, Claim.item.extension:provider, Claim.item.extension:prosthesis, Claim.item.modifierExtension, Claim.item.sequence, Claim.item.careTeamSequence, Claim.item.diagnosisSequence, Claim.item.procedureSequence, Claim.item.informationSequence, Claim.item.revenue, Claim.item.category, Claim.item.category.extension, Claim.item.category.extension:type, Claim.item.category.coding, Claim.item.category.text, Claim.item.productOrService, Claim.item.modifier, Claim.item.programCode, Claim.item.serviced[x], Claim.item.location[x], Claim.item.quantity, Claim.item.unitPrice, Claim.item.factor, Claim.item.net, Claim.item.udi, Claim.item.udi.extension, Claim.item.udi.extension:udi, Claim.item.udi.reference, Claim.item.udi.type, Claim.item.udi.identifier, Claim.item.udi.display, Claim.item.bodySite, Claim.item.subSite, Claim.item.encounter, Claim.item.detail, Claim.item.detail.extension, Claim.item.detail.modifierExtension, Claim.item.detail.sequence, Claim.item.detail.revenue, Claim.item.detail.category, Claim.item.detail.category.extension, Claim.item.detail.category.extension:type, Claim.item.detail.category.coding, Claim.item.detail.category.text, Claim.item.detail.productOrService, Claim.item.detail.modifier, Claim.item.detail.programCode, Claim.item.detail.quantity, Claim.item.detail.unitPrice, Claim.item.detail.factor, Claim.item.detail.net, Claim.item.detail.udi, Claim.item.detail.udi.extension, Claim.item.detail.udi.extension:udi, Claim.item.detail.udi.reference, Claim.item.detail.udi.type, Claim.item.detail.udi.identifier, Claim.item.detail.udi.display, Claim.item.detail.subDetail, Claim.item.detail.subDetail.extension, Claim.item.detail.subDetail.modifierExtension, Claim.item.detail.subDetail.sequence, Claim.item.detail.subDetail.revenue, Claim.item.detail.subDetail.category, Claim.item.detail.subDetail.category.extension, Claim.item.detail.subDetail.category.extension:type, Claim.item.detail.subDetail.category.coding, Claim.item.detail.subDetail.category.text, Claim.item.detail.subDetail.productOrService, Claim.item.detail.subDetail.modifier, Claim.item.detail.subDetail.programCode, Claim.item.detail.subDetail.quantity, Claim.item.detail.subDetail.unitPrice, Claim.item.detail.subDetail.factor, Claim.item.detail.subDetail.net, Claim.item.detail.subDetail.udi, Claim.item.detail.subDetail.udi.extension, Claim.item.detail.subDetail.udi.extension:udi, Claim.item.detail.subDetail.udi.reference, Claim.item.detail.subDetail.udi.type, Claim.item.detail.subDetail.udi.identifier, Claim.item.detail.subDetail.udi.display, Claim.total	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	Claim.meta.extension, Claim.meta.extension:meta, Claim.text.extension, Claim.text.extension:text, Claim.extension, Claim.extension:ruleset, Claim.extension:originalRuleset, Claim.extension:organization, Claim.extension:condition, Claim.extension:exception, Claim.extension:school, Claim.extension:interventionException, Claim.extension:additionalMaterials, Claim.extension:missingTeeth, Claim.modifierExtension, Claim.identifier.extension, Claim.identifier.extension:identifier, Claim.type.extension, Claim.type.extension:type, Claim.use.extension, Claim.use.extension:use, Claim.patient.extension, Claim.patient.extension:patient, Claim.enterer.extension, Claim.enterer.extension:enterer, Claim.insurer.extension, Claim.insurer.extension:target, Claim.provider.extension, Claim.provider.extension:provider, Claim.related.extension, Claim.related.modifierExtension, Claim.prescription.extension, Claim.prescription.extension:prescription, Claim.originalPrescription.extension, Claim.originalPrescription.extension:originalPrescription, Claim.payee.extension, Claim.payee.modifierExtension, Claim.payee.party.extension, Claim.payee.party.extension:provider, Claim.payee.party.extension:organization, Claim.payee.party.extension:person, Claim.referral.extension, Claim.referral.extension:referral, Claim.facility.extension, Claim.facility.extension:facility, Claim.careTeam.extension, Claim.careTeam.modifierExtension, Claim.supportingInfo.extension, Claim.supportingInfo.modifierExtension, Claim.diagnosis.extension, Claim.diagnosis.modifierExtension, Claim.procedure.extension, Claim.procedure.modifierExtension, Claim.insurance.extension, Claim.insurance.extension:relationship, Claim.insurance.extension:originalRuleset, Claim.insurance.modifierExtension, Claim.insurance.coverage.extension, Claim.insurance.coverage.extension:coverage, Claim.insurance.claimResponse.extension, Claim.insurance.claimResponse.extension:claimResponse, Claim.accident.extension, Claim.accident.modifierExtension, Claim.accident.type.extension, Claim.accident.type.extension:accidentType, Claim.item.extension, Claim.item.extension:provider, Claim.item.extension:prosthesis, Claim.item.modifierExtension, Claim.item.category.extension, Claim.item.category.extension:type, Claim.item.udi.extension, Claim.item.udi.extension:udi, Claim.item.detail.extension, Claim.item.detail.modifierExtension, Claim.item.detail.category.extension, Claim.item.detail.category.extension:type, Claim.item.detail.udi.extension, Claim.item.detail.udi.extension:udi, Claim.item.detail.subDetail.extension, Claim.item.detail.subDetail.modifierExtension, Claim.item.detail.subDetail.category.extension, Claim.item.detail.subDetail.category.extension:type, Claim.item.detail.subDetail.udi.extension, Claim.item.detail.subDetail.udi.extension:udi	Must have either extensions or value[x], not both	extension.exists() != value.exists()
txt-1	error	Claim.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	Claim.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

This structure is derived from Claim

Summary

Mandatory: 2 elements(6 nested mandatory elements)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.meta|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.text|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.ruleset|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.originalRuleset|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.organization|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.condition|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.exception|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.school|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.interventionException|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.additionalMaterials|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.missingTeeth|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.identifier|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.type|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.use|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.relationship|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.coverage.originalRuleset|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.accidentType|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.provider|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.prosthesis|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.type|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.udi|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.type|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.udi|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.type|0.1.0
• http://hl7.org/fhir/1.0/StructureDefinition/extension-Claim.item.detail.subDetail.udi|0.1.0

Maturity: 0