Extensions for Using Data Elements from FHIR STU3 in FHIR R4B
0.1.0 - STU International flag

Extensions for Using Data Elements from FHIR STU3 in FHIR R4B - Downloaded Version null See the Directory of published versions

Resource Profile: Profile_R3_Claim_R4B

Official URL: http://hl7.org/fhir/3.0/StructureDefinition/profile-Claim Version: 0.1.0
Standards status: Trial-use Maturity Level: 0 Computable Name: Profile_R3_Claim_R4B

This cross-version profile allows STU3 Claim content to be represented via FHIR R4B Claim resources.

Usages:

  • This Profile is not used by any profiles in this Implementation Guide

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.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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:organization 0..1 Reference(Cross-version Profile for STU3.Organization for use in FHIR R4B(0.1.0) | Organization) STU3: Responsible organization (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.organization
Constraints: ext-1
.... extension:employmentImpacted 0..1 Period STU3: Period unable to work (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.employmentImpacted
Constraints: ext-1
.... extension:hospitalization 0..1 Period STU3: Period in hospital (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.hospitalization
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... 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 0..1 CodeableConcept STU3: Type or discipline
URL: http://hl7.org/fhir/3.0/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 STU3: complete | proposed | exploratory | other
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.use
Binding: R3ClaimUseForR4B (0.1.0) (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) STU3: 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) STU3: 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
.... 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) STU3: coverage additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1

doco 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:organization, Claim.extension:employmentImpacted, Claim.extension:hospitalization, 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.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:organization, Claim.extension:employmentImpacted, Claim.extension:hospitalization, 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.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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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) STU3: meta additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.meta
... text
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:text 0..1 (Complex) STU3: text additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.text
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:organization 0..1 Reference(Cross-version Profile for STU3.Organization for use in FHIR R4B(0.1.0) | Organization) STU3: Responsible organization (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.organization
.... extension:employmentImpacted 0..1 Period STU3: Period unable to work (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.employmentImpacted
.... extension:hospitalization 0..1 Period STU3: Period in hospital (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.hospitalization
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:identifier 0..* Identifier STU3: Claim number additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.identifier
... type
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:type 0..1 CodeableConcept STU3: Type or discipline
URL: http://hl7.org/fhir/3.0/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 STU3: complete | proposed | exploratory | other
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.use
Binding: R3ClaimUseForR4B (0.1.0) (required): Complete, proposed, exploratory, other
... patient
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:patient 0..1 Reference(Resource) STU3: The subject of the Products and Services additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... billablePeriod
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:billablePeriod 0..1 Period STU3: Period for charge submission additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.billablePeriod
... enterer
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:enterer 0..1 Reference(Resource) STU3: 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:insurer 0..1 Reference(Resource) STU3: 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) STU3: Responsible provider additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... related
.... claim
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim 0..1 Reference(Resource) STU3: claim additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
.... reference
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:reference 0..1 Identifier STU3: Related file or case reference additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.related.reference
... prescription
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:prescription 0..1 Reference(Resource) STU3: Prescription authorizing services or products 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) STU3: Original prescription if superceded by fulfiller 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:resourceType 0..1 Coding STU3: organization | patient | practitioner | relatedperson additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.payee.resourceType
Binding: R3ExPayeeResourceTypeForR4B (0.1.0) (example): The type of Claim payee Resource
...... extension:party 0..1 Reference(Resource) STU3: Party to receive the payable
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) STU3: 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) STU3: Servicing Facility additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... careTeam
.... provider
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:provider 0..1 Reference(Resource) STU3: Provider individual or organization additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... supportingInfo
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:timing 0..1 Period STU3: timing additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.information.timing
..... extension:value 0..1 Attachment STU3: Additional Data or supporting information additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.information.value
.... valueReference
..... Slices for extension Content/Rules for all slices
...... extension:alternateReference 0..1 Reference(Resource) STU3: Additional Data or supporting information additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... diagnosis
.... diagnosisReference
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:alternateReference 0..1 Reference(Resource) STU3: Patient's diagnosis additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... procedure
.... procedureReference
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:alternateReference 0..1 Reference(Resource) STU3: Patient's list of procedures performed additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... insurance
.... coverage
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:coverage 0..1 Reference(Resource) STU3: 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) STU3: claimResponse additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... accident
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:location 0..1 Address STU3: Accident Place additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.accident.location
.... type
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:type 0..1 CodeableConcept ​STU3: type
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.accident.type
Binding: http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|2.0.0 (required): Type of accident: work place, auto, etc.
.... locationReference
..... Slices for extension Content/Rules for all slices
...... extension:alternateReference 0..1 Reference(Resource) STU3: Accident Place additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... item
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:serviced 0..1 Period STU3: Date or dates of Service additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.item.serviced
..... extension:location 0..1 Address STU3: Place of service additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.item.location
.... locationReference
..... Slices for extension Content/Rules for all slices
...... extension:alternateReference 0..1 Reference(Resource) STU3: Place of service additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
.... udi
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:udi 0..* Reference(Resource) STU3: Unique Device Identifier additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
.... encounter
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:encounter 0..* Reference(Resource) STU3: encounter additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
.... detail
..... udi
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... extension:udi 0..* Reference(Resource) STU3: Unique Device Identifier additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
..... subDetail
...... udi
....... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
........ extension:udi 0..* Reference(Resource) STU3: Unique Device Identifier additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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) STU3: meta additional types
URL: http://hl7.org/fhir/3.0/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 BindingsPurpose
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) STU3: text additional types
URL: http://hl7.org/fhir/3.0/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:organization 0..1 Reference(Cross-version Profile for STU3.Organization for use in FHIR R4B(0.1.0) | Organization) STU3: Responsible organization (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.organization
Constraints: ext-1
.... extension:employmentImpacted 0..1 Period STU3: Period unable to work (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.employmentImpacted
Constraints: ext-1
.... extension:hospitalization 0..1 Period STU3: Period in hospital (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.hospitalization
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 STU3: Claim number additional types
URL: http://hl7.org/fhir/3.0/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 0..1 CodeableConcept STU3: Type or discipline
URL: http://hl7.org/fhir/3.0/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 STU3: complete | proposed | exploratory | other
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.use
Binding: R3ClaimUseForR4B (0.1.0) (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) STU3: 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
.... 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:billablePeriod 0..1 Period STU3: Period for charge submission additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.billablePeriod
Constraints: ext-1
.... start ΣC 0..1 dateTime Starting time with inclusive boundary
.... end ΣC 0..1 dateTime End time with inclusive boundary, if not ongoing
... 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) STU3: 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:insurer 0..1 Reference(Resource) STU3: 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) STU3: 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
..... 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:claim 0..1 Reference(Resource) STU3: claim 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
.... 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
..... 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:reference 0..1 Identifier STU3: Related file or case reference additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.related.reference
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)
... 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) STU3: Prescription authorizing services or products 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) STU3: Original prescription if superceded by fulfiller 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:resourceType 0..1 Coding STU3: organization | patient | practitioner | relatedperson additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.payee.resourceType
Binding: R3ExPayeeResourceTypeForR4B (0.1.0) (example): The type of Claim payee Resource
Constraints: ext-1
...... extension:party 0..1 Reference(Resource) STU3: Party to receive the payable
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) STU3: 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) STU3: 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
..... 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) STU3: Provider individual or organization 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
.... 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
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:timing 0..1 Period STU3: timing additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.information.timing
Constraints: ext-1
..... extension:value 0..1 Attachment STU3: Additional Data or supporting information additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.information.value
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
..... value[x]All Types Content/Rules for all Types
...... id 0..1 id Unique id for inter-element referencing
...... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... extension:alternateReference 0..1 Reference(Resource) STU3: Additional Data or supporting information additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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.
..... diagnosis[x]All Types Content/Rules for all Types
...... 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:alternateReference 0..1 Reference(Resource) STU3: Patient's diagnosis additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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.
..... procedure[x]All Types Content/Rules for all Types
...... 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:alternateReference 0..1 Reference(Resource) STU3: Patient's list of procedures performed additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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
.... 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 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) STU3: 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) STU3: 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
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:location 0..1 Address STU3: Accident Place additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.accident.location
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:type 0..1 CodeableConcept ​STU3: type
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.accident.type
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
..... location[x]All Types Content/Rules for all Types
...... id 0..1 id Unique id for inter-element referencing
...... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... extension:alternateReference 0..1 Reference(Resource) STU3: Accident Place additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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:serviced 0..1 Period STU3: Date or dates of Service additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.item.serviced
Constraints: ext-1
..... extension:location 0..1 Address STU3: Place of service additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.item.location
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.
.... 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.
..... location[x]All Types Content/Rules for all Types
...... id 0..1 id Unique id for inter-element referencing
...... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... extension:alternateReference 0..1 Reference(Resource) STU3: Place of service additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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 Reference(Resource) STU3: Unique Device Identifier 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
.... 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
..... 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:encounter 0..1 Reference(Resource) STU3: encounter 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
.... 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.
..... 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 Reference(Resource) STU3: Unique Device Identifier 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
..... 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.
...... 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 Reference(Resource) STU3: Unique Device Identifier 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
... total 0..1 Money Total claim cost

doco 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.claim.​type Base extensible ResourceType 📍4.3.0 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.3.0 FHIR Std.
Claim.related.reference.​use Base required IdentifierUse 📍4.3.0 FHIR Std.
Claim.related.reference.​type Base extensible IdentifierType 📍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.provider.​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.encounter.​type Base extensible ResourceType 📍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:organization, Claim.extension:employmentImpacted, Claim.extension:hospitalization, 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.billablePeriod.extension, Claim.billablePeriod.extension:billablePeriod, Claim.billablePeriod.start, Claim.billablePeriod.end, 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:insurer, 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.claim.extension, Claim.related.claim.extension:claim, Claim.related.claim.reference, Claim.related.claim.type, Claim.related.claim.identifier, Claim.related.claim.display, Claim.related.relationship, Claim.related.reference, Claim.related.reference.extension, Claim.related.reference.extension:reference, Claim.related.reference.use, Claim.related.reference.type, Claim.related.reference.system, Claim.related.reference.value, Claim.related.reference.period, Claim.related.reference.assigner, 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:resourceType, Claim.payee.party.extension:party, 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.provider.extension, Claim.careTeam.provider.extension:provider, Claim.careTeam.provider.reference, Claim.careTeam.provider.type, Claim.careTeam.provider.identifier, Claim.careTeam.provider.display, Claim.careTeam.responsible, Claim.careTeam.role, Claim.careTeam.qualification, Claim.supportingInfo, Claim.supportingInfo.extension, Claim.supportingInfo.extension:timing, Claim.supportingInfo.extension:value, Claim.supportingInfo.modifierExtension, Claim.supportingInfo.sequence, Claim.supportingInfo.category, Claim.supportingInfo.code, Claim.supportingInfo.timing[x], Claim.supportingInfo.value[x], Claim.supportingInfo.value[x].extension, Claim.supportingInfo.value[x].extension:alternateReference, Claim.supportingInfo.reason, Claim.diagnosis, Claim.diagnosis.extension, Claim.diagnosis.modifierExtension, Claim.diagnosis.sequence, Claim.diagnosis.diagnosis[x], Claim.diagnosis.diagnosis[x].extension, Claim.diagnosis.diagnosis[x].extension:alternateReference, 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.procedure[x].extension, Claim.procedure.procedure[x].extension:alternateReference, Claim.procedure.udi, Claim.insurance, Claim.insurance.extension, 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.extension:location, Claim.accident.modifierExtension, Claim.accident.date, Claim.accident.type, Claim.accident.type.extension, Claim.accident.type.extension:type, Claim.accident.type.coding, Claim.accident.type.text, Claim.accident.location[x], Claim.accident.location[x].extension, Claim.accident.location[x].extension:alternateReference, Claim.item, Claim.item.extension, Claim.item.extension:serviced, Claim.item.extension:location, 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.productOrService, Claim.item.modifier, Claim.item.programCode, Claim.item.serviced[x], Claim.item.location[x], Claim.item.location[x].extension, Claim.item.location[x].extension:alternateReference, 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.encounter.extension, Claim.item.encounter.extension:encounter, Claim.item.encounter.reference, Claim.item.encounter.type, Claim.item.encounter.identifier, Claim.item.encounter.display, 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.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.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:organization, Claim.extension:employmentImpacted, Claim.extension:hospitalization, 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.billablePeriod.extension, Claim.billablePeriod.extension:billablePeriod, Claim.enterer.extension, Claim.enterer.extension:enterer, Claim.insurer.extension, Claim.insurer.extension:insurer, Claim.provider.extension, Claim.provider.extension:provider, Claim.related.extension, Claim.related.modifierExtension, Claim.related.claim.extension, Claim.related.claim.extension:claim, Claim.related.reference.extension, Claim.related.reference.extension:reference, 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:resourceType, Claim.payee.party.extension:party, Claim.referral.extension, Claim.referral.extension:referral, Claim.facility.extension, Claim.facility.extension:facility, Claim.careTeam.extension, Claim.careTeam.modifierExtension, Claim.careTeam.provider.extension, Claim.careTeam.provider.extension:provider, Claim.supportingInfo.extension, Claim.supportingInfo.extension:timing, Claim.supportingInfo.extension:value, Claim.supportingInfo.modifierExtension, Claim.supportingInfo.value[x].extension, Claim.supportingInfo.value[x].extension:alternateReference, Claim.diagnosis.extension, Claim.diagnosis.modifierExtension, Claim.diagnosis.diagnosis[x].extension, Claim.diagnosis.diagnosis[x].extension:alternateReference, Claim.procedure.extension, Claim.procedure.modifierExtension, Claim.procedure.procedure[x].extension, Claim.procedure.procedure[x].extension:alternateReference, Claim.insurance.extension, 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.extension:location, Claim.accident.modifierExtension, Claim.accident.type.extension, Claim.accident.type.extension:type, Claim.accident.location[x].extension, Claim.accident.location[x].extension:alternateReference, Claim.item.extension, Claim.item.extension:serviced, Claim.item.extension:location, Claim.item.modifierExtension, Claim.item.location[x].extension, Claim.item.location[x].extension:alternateReference, Claim.item.udi.extension, Claim.item.udi.extension:udi, Claim.item.encounter.extension, Claim.item.encounter.extension:encounter, Claim.item.detail.extension, Claim.item.detail.modifierExtension, 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.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

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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:organization 0..1 Reference(Cross-version Profile for STU3.Organization for use in FHIR R4B(0.1.0) | Organization) STU3: Responsible organization (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.organization
Constraints: ext-1
.... extension:employmentImpacted 0..1 Period STU3: Period unable to work (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.employmentImpacted
Constraints: ext-1
.... extension:hospitalization 0..1 Period STU3: Period in hospital (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.hospitalization
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... 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 0..1 CodeableConcept STU3: Type or discipline
URL: http://hl7.org/fhir/3.0/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 STU3: complete | proposed | exploratory | other
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.use
Binding: R3ClaimUseForR4B (0.1.0) (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) STU3: 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) STU3: 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
.... 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) STU3: coverage additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1

doco 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:organization, Claim.extension:employmentImpacted, Claim.extension:hospitalization, 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.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:organization, Claim.extension:employmentImpacted, Claim.extension:hospitalization, 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.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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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) STU3: meta additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.meta
... text
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:text 0..1 (Complex) STU3: text additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.text
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:organization 0..1 Reference(Cross-version Profile for STU3.Organization for use in FHIR R4B(0.1.0) | Organization) STU3: Responsible organization (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.organization
.... extension:employmentImpacted 0..1 Period STU3: Period unable to work (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.employmentImpacted
.... extension:hospitalization 0..1 Period STU3: Period in hospital (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.hospitalization
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:identifier 0..* Identifier STU3: Claim number additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.identifier
... type
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:type 0..1 CodeableConcept STU3: Type or discipline
URL: http://hl7.org/fhir/3.0/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 STU3: complete | proposed | exploratory | other
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.use
Binding: R3ClaimUseForR4B (0.1.0) (required): Complete, proposed, exploratory, other
... patient
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:patient 0..1 Reference(Resource) STU3: The subject of the Products and Services additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... billablePeriod
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:billablePeriod 0..1 Period STU3: Period for charge submission additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.billablePeriod
... enterer
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:enterer 0..1 Reference(Resource) STU3: 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:insurer 0..1 Reference(Resource) STU3: 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) STU3: Responsible provider additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... related
.... claim
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim 0..1 Reference(Resource) STU3: claim additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
.... reference
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:reference 0..1 Identifier STU3: Related file or case reference additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.related.reference
... prescription
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:prescription 0..1 Reference(Resource) STU3: Prescription authorizing services or products 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) STU3: Original prescription if superceded by fulfiller 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:resourceType 0..1 Coding STU3: organization | patient | practitioner | relatedperson additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.payee.resourceType
Binding: R3ExPayeeResourceTypeForR4B (0.1.0) (example): The type of Claim payee Resource
...... extension:party 0..1 Reference(Resource) STU3: Party to receive the payable
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) STU3: 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) STU3: Servicing Facility additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... careTeam
.... provider
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:provider 0..1 Reference(Resource) STU3: Provider individual or organization additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... supportingInfo
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:timing 0..1 Period STU3: timing additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.information.timing
..... extension:value 0..1 Attachment STU3: Additional Data or supporting information additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.information.value
.... valueReference
..... Slices for extension Content/Rules for all slices
...... extension:alternateReference 0..1 Reference(Resource) STU3: Additional Data or supporting information additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... diagnosis
.... diagnosisReference
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:alternateReference 0..1 Reference(Resource) STU3: Patient's diagnosis additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... procedure
.... procedureReference
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:alternateReference 0..1 Reference(Resource) STU3: Patient's list of procedures performed additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... insurance
.... coverage
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:coverage 0..1 Reference(Resource) STU3: 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) STU3: claimResponse additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... accident
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:location 0..1 Address STU3: Accident Place additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.accident.location
.... type
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:type 0..1 CodeableConcept ​STU3: type
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.accident.type
Binding: http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|2.0.0 (required): Type of accident: work place, auto, etc.
.... locationReference
..... Slices for extension Content/Rules for all slices
...... extension:alternateReference 0..1 Reference(Resource) STU3: Accident Place additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
... item
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:serviced 0..1 Period STU3: Date or dates of Service additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.item.serviced
..... extension:location 0..1 Address STU3: Place of service additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.item.location
.... locationReference
..... Slices for extension Content/Rules for all slices
...... extension:alternateReference 0..1 Reference(Resource) STU3: Place of service additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
.... udi
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:udi 0..* Reference(Resource) STU3: Unique Device Identifier additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
.... encounter
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:encounter 0..* Reference(Resource) STU3: encounter additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
.... detail
..... udi
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... extension:udi 0..* Reference(Resource) STU3: Unique Device Identifier additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
..... subDetail
...... udi
....... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
........ extension:udi 0..* Reference(Resource) STU3: Unique Device Identifier additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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) STU3: meta additional types
URL: http://hl7.org/fhir/3.0/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 BindingsPurpose
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) STU3: text additional types
URL: http://hl7.org/fhir/3.0/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:organization 0..1 Reference(Cross-version Profile for STU3.Organization for use in FHIR R4B(0.1.0) | Organization) STU3: Responsible organization (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.organization
Constraints: ext-1
.... extension:employmentImpacted 0..1 Period STU3: Period unable to work (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.employmentImpacted
Constraints: ext-1
.... extension:hospitalization 0..1 Period STU3: Period in hospital (new)
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.hospitalization
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 STU3: Claim number additional types
URL: http://hl7.org/fhir/3.0/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 0..1 CodeableConcept STU3: Type or discipline
URL: http://hl7.org/fhir/3.0/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 STU3: complete | proposed | exploratory | other
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.use
Binding: R3ClaimUseForR4B (0.1.0) (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) STU3: 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
.... 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:billablePeriod 0..1 Period STU3: Period for charge submission additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.billablePeriod
Constraints: ext-1
.... start ΣC 0..1 dateTime Starting time with inclusive boundary
.... end ΣC 0..1 dateTime End time with inclusive boundary, if not ongoing
... 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) STU3: 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:insurer 0..1 Reference(Resource) STU3: 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) STU3: 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
..... 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:claim 0..1 Reference(Resource) STU3: claim 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
.... 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
..... 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:reference 0..1 Identifier STU3: Related file or case reference additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.related.reference
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)
... 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) STU3: Prescription authorizing services or products 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) STU3: Original prescription if superceded by fulfiller 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:resourceType 0..1 Coding STU3: organization | patient | practitioner | relatedperson additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.payee.resourceType
Binding: R3ExPayeeResourceTypeForR4B (0.1.0) (example): The type of Claim payee Resource
Constraints: ext-1
...... extension:party 0..1 Reference(Resource) STU3: Party to receive the payable
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) STU3: 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) STU3: 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
..... 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) STU3: Provider individual or organization 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
.... 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
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:timing 0..1 Period STU3: timing additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.information.timing
Constraints: ext-1
..... extension:value 0..1 Attachment STU3: Additional Data or supporting information additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.information.value
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
..... value[x]All Types Content/Rules for all Types
...... id 0..1 id Unique id for inter-element referencing
...... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... extension:alternateReference 0..1 Reference(Resource) STU3: Additional Data or supporting information additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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.
..... diagnosis[x]All Types Content/Rules for all Types
...... 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:alternateReference 0..1 Reference(Resource) STU3: Patient's diagnosis additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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.
..... procedure[x]All Types Content/Rules for all Types
...... 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:alternateReference 0..1 Reference(Resource) STU3: Patient's list of procedures performed additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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
.... 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 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) STU3: 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) STU3: 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
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:location 0..1 Address STU3: Accident Place additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.accident.location
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:type 0..1 CodeableConcept ​STU3: type
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.accident.type
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
..... location[x]All Types Content/Rules for all Types
...... id 0..1 id Unique id for inter-element referencing
...... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... extension:alternateReference 0..1 Reference(Resource) STU3: Accident Place additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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:serviced 0..1 Period STU3: Date or dates of Service additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.item.serviced
Constraints: ext-1
..... extension:location 0..1 Address STU3: Place of service additional types
URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-Claim.item.location
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.
.... 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.
..... location[x]All Types Content/Rules for all Types
...... id 0..1 id Unique id for inter-element referencing
...... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... extension:alternateReference 0..1 Reference(Resource) STU3: Place of service additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Constraints: ext-1
..... 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 Reference(Resource) STU3: Unique Device Identifier 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
.... 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
..... 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:encounter 0..1 Reference(Resource) STU3: encounter 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
.... 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.
..... 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 Reference(Resource) STU3: Unique Device Identifier 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
..... 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.
...... 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 Reference(Resource) STU3: Unique Device Identifier 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
... total 0..1 Money Total claim cost

doco 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.claim.​type Base extensible ResourceType 📍4.3.0 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.3.0 FHIR Std.
Claim.related.reference.​use Base required IdentifierUse 📍4.3.0 FHIR Std.
Claim.related.reference.​type Base extensible IdentifierType 📍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.provider.​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.encounter.​type Base extensible ResourceType 📍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:organization, Claim.extension:employmentImpacted, Claim.extension:hospitalization, 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.billablePeriod.extension, Claim.billablePeriod.extension:billablePeriod, Claim.billablePeriod.start, Claim.billablePeriod.end, 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:insurer, 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.claim.extension, Claim.related.claim.extension:claim, Claim.related.claim.reference, Claim.related.claim.type, Claim.related.claim.identifier, Claim.related.claim.display, Claim.related.relationship, Claim.related.reference, Claim.related.reference.extension, Claim.related.reference.extension:reference, Claim.related.reference.use, Claim.related.reference.type, Claim.related.reference.system, Claim.related.reference.value, Claim.related.reference.period, Claim.related.reference.assigner, 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:resourceType, Claim.payee.party.extension:party, 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.provider.extension, Claim.careTeam.provider.extension:provider, Claim.careTeam.provider.reference, Claim.careTeam.provider.type, Claim.careTeam.provider.identifier, Claim.careTeam.provider.display, Claim.careTeam.responsible, Claim.careTeam.role, Claim.careTeam.qualification, Claim.supportingInfo, Claim.supportingInfo.extension, Claim.supportingInfo.extension:timing, Claim.supportingInfo.extension:value, Claim.supportingInfo.modifierExtension, Claim.supportingInfo.sequence, Claim.supportingInfo.category, Claim.supportingInfo.code, Claim.supportingInfo.timing[x], Claim.supportingInfo.value[x], Claim.supportingInfo.value[x].extension, Claim.supportingInfo.value[x].extension:alternateReference, Claim.supportingInfo.reason, Claim.diagnosis, Claim.diagnosis.extension, Claim.diagnosis.modifierExtension, Claim.diagnosis.sequence, Claim.diagnosis.diagnosis[x], Claim.diagnosis.diagnosis[x].extension, Claim.diagnosis.diagnosis[x].extension:alternateReference, 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.procedure[x].extension, Claim.procedure.procedure[x].extension:alternateReference, Claim.procedure.udi, Claim.insurance, Claim.insurance.extension, 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.extension:location, Claim.accident.modifierExtension, Claim.accident.date, Claim.accident.type, Claim.accident.type.extension, Claim.accident.type.extension:type, Claim.accident.type.coding, Claim.accident.type.text, Claim.accident.location[x], Claim.accident.location[x].extension, Claim.accident.location[x].extension:alternateReference, Claim.item, Claim.item.extension, Claim.item.extension:serviced, Claim.item.extension:location, 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.productOrService, Claim.item.modifier, Claim.item.programCode, Claim.item.serviced[x], Claim.item.location[x], Claim.item.location[x].extension, Claim.item.location[x].extension:alternateReference, 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.encounter.extension, Claim.item.encounter.extension:encounter, Claim.item.encounter.reference, Claim.item.encounter.type, Claim.item.encounter.identifier, Claim.item.encounter.display, 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.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.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:organization, Claim.extension:employmentImpacted, Claim.extension:hospitalization, 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.billablePeriod.extension, Claim.billablePeriod.extension:billablePeriod, Claim.enterer.extension, Claim.enterer.extension:enterer, Claim.insurer.extension, Claim.insurer.extension:insurer, Claim.provider.extension, Claim.provider.extension:provider, Claim.related.extension, Claim.related.modifierExtension, Claim.related.claim.extension, Claim.related.claim.extension:claim, Claim.related.reference.extension, Claim.related.reference.extension:reference, 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:resourceType, Claim.payee.party.extension:party, Claim.referral.extension, Claim.referral.extension:referral, Claim.facility.extension, Claim.facility.extension:facility, Claim.careTeam.extension, Claim.careTeam.modifierExtension, Claim.careTeam.provider.extension, Claim.careTeam.provider.extension:provider, Claim.supportingInfo.extension, Claim.supportingInfo.extension:timing, Claim.supportingInfo.extension:value, Claim.supportingInfo.modifierExtension, Claim.supportingInfo.value[x].extension, Claim.supportingInfo.value[x].extension:alternateReference, Claim.diagnosis.extension, Claim.diagnosis.modifierExtension, Claim.diagnosis.diagnosis[x].extension, Claim.diagnosis.diagnosis[x].extension:alternateReference, Claim.procedure.extension, Claim.procedure.modifierExtension, Claim.procedure.procedure[x].extension, Claim.procedure.procedure[x].extension:alternateReference, Claim.insurance.extension, 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.extension:location, Claim.accident.modifierExtension, Claim.accident.type.extension, Claim.accident.type.extension:type, Claim.accident.location[x].extension, Claim.accident.location[x].extension:alternateReference, Claim.item.extension, Claim.item.extension:serviced, Claim.item.extension:location, Claim.item.modifierExtension, Claim.item.location[x].extension, Claim.item.location[x].extension:alternateReference, Claim.item.udi.extension, Claim.item.udi.extension:udi, Claim.item.encounter.extension, Claim.item.encounter.extension:encounter, Claim.item.detail.extension, Claim.item.detail.modifierExtension, 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.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

 

Other representations of profile: CSV, Excel, Schematron