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

The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

An Extension

STU3: Claim.organization (new:Reference(Organization))

Element Claim.organization has a context of Claim based on following the parent source element upwards and mapping to Claim. Element Claim.organization has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: Claim.employmentImpacted (new:Period)

Element Claim.employmentImpacted has a context of Claim based on following the parent source element upwards and mapping to Claim. Element Claim.employmentImpacted has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: Claim.hospitalization (new:Period)

Element Claim.hospitalization has a context of Claim based on following the parent source element upwards and mapping to Claim. Element Claim.hospitalization has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The status of the resource instance.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

A code specifying the state of the resource instance.

Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

The code system provides oral, pharmacy, vision, professional and institutional claim types. Those supported depends on the requirements of the jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction.

The type or discipline-style of the claim.

Claim type determine the general sets of business rules applied for information requirements and adjudication.

An Extension

STU3: Claim.type

Element Claim.type is mapped to FHIR R5 element Claim.type as Equivalent. Affects which fields and value sets are used.

A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided.

The codes SHALL be taken from Use http://hl7.org/fhir/ValueSet/claim-use|5.0.0
(required to http://hl7.org/fhir/ValueSet/claim-use|5.0.0)

The purpose of the Claim: predetermination, preauthorization, claim.

This element is required to understand the nature of the request for adjudication.

An Extension

STU3: Claim.use

Element Claim.use is mapped to FHIR R5 element Claim.use as SourceIsBroaderThanTarget.

The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

An Extension

STU3: Claim.patient additional types from child elements (display, identifier, reference)

Element Claim.patient is mapped to FHIR R5 element Claim.patient as SourceIsBroaderThanTarget. The mappings for Claim.patient do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.patient with unmapped reference targets: Patient.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The date this resource was created.

This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

Need to record a timestamp for use by both the recipient and the issuer.

STU3: Claim.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Element Claim.meta is mapped to FHIR R5 element Claim.meta as SourceIsBroaderThanTarget. The mappings for Claim.meta do not cover the following types: Meta. The mappings for Claim.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

STU3: Claim.text additional types (Narrative) additional types from child elements (div, status)

Element Claim.text is mapped to FHIR R5 element Claim.text as SourceIsBroaderThanTarget. The mappings for Claim.text do not cover the following types: Narrative. The mappings for Claim.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

STU3: Claim.organization (new:Reference(Organization))

Element Claim.organization has a context of Claim based on following the parent source element upwards and mapping to Claim. Element Claim.organization has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: Claim.employmentImpacted (new:Period)

Element Claim.employmentImpacted has a context of Claim based on following the parent source element upwards and mapping to Claim. Element Claim.employmentImpacted has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: Claim.hospitalization (new:Period)

Element Claim.hospitalization has a context of Claim based on following the parent source element upwards and mapping to Claim. Element Claim.hospitalization has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: Claim.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element Claim.identifier is mapped to FHIR R5 element Claim.identifier as SourceIsBroaderThanTarget. The mappings for Claim.identifier do not cover the following types: Identifier. The mappings for Claim.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

STU3: Claim.type

Element Claim.type is mapped to FHIR R5 element Claim.type as Equivalent. Affects which fields and value sets are used.

STU3: Claim.use

Element Claim.use is mapped to FHIR R5 element Claim.use as SourceIsBroaderThanTarget.

STU3: Claim.patient additional types from child elements (display, identifier, reference)

Element Claim.patient is mapped to FHIR R5 element Claim.patient as SourceIsBroaderThanTarget. The mappings for Claim.patient do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.patient with unmapped reference targets: Patient.

STU3: Claim.billablePeriod additional types (Period) additional types from child elements (end, start)

Element Claim.billablePeriod is mapped to FHIR R5 element Claim.billablePeriod as SourceIsBroaderThanTarget. The mappings for Claim.billablePeriod do not cover the following types: Period. The mappings for Claim.billablePeriod do not cover the following types based on type expansion: end, start.

STU3: Claim.enterer additional types from child elements (display, identifier, reference)

Element Claim.enterer is mapped to FHIR R5 element Claim.enterer as SourceIsBroaderThanTarget. The mappings for Claim.enterer do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.enterer with unmapped reference targets: Practitioner.

STU3: Claim.insurer additional types from child elements (display, identifier, reference)

Element Claim.insurer is mapped to FHIR R5 element Claim.insurer as SourceIsBroaderThanTarget. The mappings for Claim.insurer do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.insurer with unmapped reference targets: Organization.

STU3: Claim.provider additional types from child elements (display, identifier, reference)

Element Claim.provider is mapped to FHIR R5 element Claim.provider as SourceIsBroaderThanTarget. The mappings for Claim.provider do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.provider with unmapped reference targets: Practitioner.

STU3: Claim.related.claim additional types from child elements (display, identifier, reference)

Element Claim.related.claim is mapped to FHIR R5 element Claim.related.claim as SourceIsBroaderThanTarget. The mappings for Claim.related.claim do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.related.claim with unmapped reference targets: Claim. Do we need a relationship code?

STU3: Claim.related.reference additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element Claim.related.reference is mapped to FHIR R5 element Claim.related.reference as SourceIsBroaderThanTarget. The mappings for Claim.related.reference do not cover the following types: Identifier. The mappings for Claim.related.reference do not cover the following types based on type expansion: assigner, period, system, type, use, value.

STU3: Claim.prescription additional types from child elements (display, identifier, reference)

Element Claim.prescription is mapped to FHIR R5 element Claim.prescription as SourceIsBroaderThanTarget. The mappings for Claim.prescription do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.prescription with unmapped reference targets: MedicationRequest, VisionPrescription. Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence.

STU3: Claim.originalPrescription additional types from child elements (display, identifier, reference)

Element Claim.originalPrescription is mapped to FHIR R5 element Claim.originalPrescription as SourceIsBroaderThanTarget. The mappings for Claim.originalPrescription do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.originalPrescription with unmapped reference targets: MedicationRequest. as above.

STU3: Claim.payee.resourceType additional types (Coding) additional types from child elements (code, display, system, userSelected, version)

Element Claim.payee.resourceType is mapped to FHIR R5 element Claim.payee.party as SourceIsBroaderThanTarget. The mappings for Claim.payee.resourceType do not cover the following types: Coding. The mappings for Claim.payee.resourceType do not cover the following types based on type expansion: code, display, system, userSelected, version.

STU3: Claim.payee.party

Element Claim.payee.party is mapped to FHIR R5 element Claim.payee.party as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.payee.party with unmapped reference targets: Organization, Patient, Practitioner, RelatedPerson.

STU3: Claim.referral additional types from child elements (display, identifier, reference)

Element Claim.referral is mapped to FHIR R5 element Claim.referral as RelatedTo. The mappings for Claim.referral do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.referral with unmapped reference targets: ReferralRequest.

STU3: Claim.facility additional types from child elements (display, identifier, reference)

Element Claim.facility is mapped to FHIR R5 element Claim.facility as SourceIsBroaderThanTarget. The mappings for Claim.facility do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.facility with unmapped reference targets: Location.

STU3: Claim.careTeam.provider additional types from child elements (display, identifier, reference)

Element Claim.careTeam.provider is mapped to FHIR R5 element Claim.careTeam.provider as SourceIsBroaderThanTarget. The mappings for Claim.careTeam.provider do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.careTeam.provider with unmapped reference targets: Organization, Practitioner.

STU3: Claim.information.timing[x] additional types (Period) additional types from child elements (end, start)

Element Claim.information.timing[x] is mapped to FHIR R5 element Claim.supportingInfo.timing[x] as SourceIsBroaderThanTarget. The mappings for Claim.information.timing[x] do not cover the following types: Period. The mappings for Claim.information.timing[x] do not cover the following types based on type expansion: end, start. The target context Claim.supportingInfo.timing[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Claim.supportingInfo.

STU3: Claim.information.value[x] additional types (Attachment)

Element Claim.information.value[x] is mapped to FHIR R5 element Claim.supportingInfo.value[x] as SourceIsBroaderThanTarget. The mappings for Claim.information.value[x] do not cover the following types: Attachment. The target context Claim.supportingInfo.value[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Claim.supportingInfo. The standard extension alternate-reference has been mapped as PART of the representation of FHIR STU3 element Claim.information.value[x] with unmapped reference targets: Resource. Source element Claim.information.value[x] has unmapped reference types. While the target element Claim.supportingInfo.value[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it.

STU3: Claim.information.value[x] additional types (Attachment)

Element Claim.information.value[x] is mapped to FHIR R5 element Claim.supportingInfo.value[x] as SourceIsBroaderThanTarget. The mappings for Claim.information.value[x] do not cover the following types: Attachment. The target context Claim.supportingInfo.value[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Claim.supportingInfo. The standard extension alternate-reference has been mapped as PART of the representation of FHIR STU3 element Claim.information.value[x] with unmapped reference targets: Resource. Source element Claim.information.value[x] has unmapped reference types. While the target element Claim.supportingInfo.value[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it.

STU3: Claim.diagnosis.packageCode (new:CodeableConcept)

Element Claim.diagnosis.packageCode has a context of Claim.diagnosis based on following the parent source element upwards and mapping to Claim. Element Claim.diagnosis.packageCode has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: Claim.diagnosis.diagnosis[x] additional types from child elements (display, identifier, reference)

Element Claim.diagnosis.diagnosis[x] is mapped to FHIR R5 element Claim.diagnosis.diagnosis[x] as SourceIsBroaderThanTarget. The mappings for Claim.diagnosis.diagnosis[x] do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.diagnosis.diagnosis[x] with unmapped reference targets: Condition. Source element Claim.diagnosis.diagnosis[x] has unmapped reference types. While the target element Claim.diagnosis.diagnosis[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it.

STU3: Claim.procedure.procedure[x] additional types from child elements (display, identifier, reference)

Element Claim.procedure.procedure[x] is mapped to FHIR R5 element Claim.procedure.procedure[x] as SourceIsBroaderThanTarget. The mappings for Claim.procedure.procedure[x] do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.procedure.procedure[x] with unmapped reference targets: Procedure. Source element Claim.procedure.procedure[x] has unmapped reference types. While the target element Claim.procedure.procedure[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it.

STU3: Claim.insurance.coverage additional types from child elements (display, identifier, reference)

Element Claim.insurance.coverage is mapped to FHIR R5 element Claim.insurance.coverage as SourceIsBroaderThanTarget. The mappings for Claim.insurance.coverage do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.insurance.coverage with unmapped reference targets: Coverage.

STU3: Claim.insurance.claimResponse additional types from child elements (display, identifier, reference)

Element Claim.insurance.claimResponse is mapped to FHIR R5 element Claim.insurance.claimResponse as SourceIsBroaderThanTarget. The mappings for Claim.insurance.claimResponse do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.insurance.claimResponse with unmapped reference targets: ClaimResponse.

STU3: Claim.accident.location[x] additional types (Address) additional types from child elements (city, country, district, line, period, postalCode, state, text, type, use, display, identifier, reference)

Element Claim.accident.location[x] is mapped to FHIR R5 element Claim.accident.location[x] as SourceIsBroaderThanTarget. The mappings for Claim.accident.location[x] do not cover the following types: Address. The mappings for Claim.accident.location[x] do not cover the following types based on type expansion: city, country, display, district, identifier, line, period, postalCode, reference, state, text, type, use. The target context Claim.accident.location[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Claim.accident. The standard extension alternate-reference has been mapped as PART of the representation of FHIR STU3 element Claim.accident.location[x] with unmapped reference targets: Location. Source element Claim.accident.location[x] has unmapped reference types. While the target element Claim.accident.location[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it.

STU3: Claim.accident.type

Element Claim.accident.type is mapped to FHIR R5 element Claim.accident.type as Equivalent.

STU3: Claim.accident.location[x] additional types (Address) additional types from child elements (city, country, district, line, period, postalCode, state, text, type, use, display, identifier, reference)

Element Claim.accident.location[x] is mapped to FHIR R5 element Claim.accident.location[x] as SourceIsBroaderThanTarget. The mappings for Claim.accident.location[x] do not cover the following types: Address. The mappings for Claim.accident.location[x] do not cover the following types based on type expansion: city, country, display, district, identifier, line, period, postalCode, reference, state, text, type, use. The target context Claim.accident.location[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Claim.accident. The standard extension alternate-reference has been mapped as PART of the representation of FHIR STU3 element Claim.accident.location[x] with unmapped reference targets: Location. Source element Claim.accident.location[x] has unmapped reference types. While the target element Claim.accident.location[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it.

STU3: Claim.item.serviced[x] additional types (Period) additional types from child elements (end, start)

Element Claim.item.serviced[x] is mapped to FHIR R5 element Claim.item.serviced[x] as SourceIsBroaderThanTarget. The mappings for Claim.item.serviced[x] do not cover the following types: Period. The mappings for Claim.item.serviced[x] do not cover the following types based on type expansion: end, start. The target context Claim.item.serviced[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Claim.item.

STU3: Claim.item.location[x] additional types (Address)

Element Claim.item.location[x] is mapped to FHIR R5 element Claim.item.location[x] as SourceIsBroaderThanTarget. The mappings for Claim.item.location[x] do not cover the following types: Address. The target context Claim.item.location[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Claim.item. The standard extension alternate-reference has been mapped as PART of the representation of FHIR STU3 element Claim.item.location[x] with unmapped reference targets: Location. Source element Claim.item.location[x] has unmapped reference types. While the target element Claim.item.location[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it.

STU3: Claim.item.subSite (new:CodeableConcept)

Element Claim.item.subSite has a context of Claim.item based on following the parent source element upwards and mapping to Claim. Element Claim.item.subSite has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: Claim.item.location[x] additional types (Address)

Element Claim.item.location[x] is mapped to FHIR R5 element Claim.item.location[x] as SourceIsBroaderThanTarget. The mappings for Claim.item.location[x] do not cover the following types: Address. The target context Claim.item.location[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Claim.item. The standard extension alternate-reference has been mapped as PART of the representation of FHIR STU3 element Claim.item.location[x] with unmapped reference targets: Location. Source element Claim.item.location[x] has unmapped reference types. While the target element Claim.item.location[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it.

STU3: Claim.item.udi additional types from child elements (display, identifier, reference)

Element Claim.item.udi is mapped to FHIR R5 element Claim.item.udi as SourceIsBroaderThanTarget. The mappings for Claim.item.udi do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.item.udi with unmapped reference targets: Device.

STU3: Claim.item.encounter additional types from child elements (display, identifier, reference)

Element Claim.item.encounter is mapped to FHIR R5 element Claim.item.encounter as SourceIsBroaderThanTarget. The mappings for Claim.item.encounter do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.item.encounter with unmapped reference targets: Encounter.

STU3: Claim.item.detail.udi additional types from child elements (display, identifier, reference)

Element Claim.item.detail.udi is mapped to FHIR R5 element Claim.item.detail.udi as SourceIsBroaderThanTarget. The mappings for Claim.item.detail.udi do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.item.detail.udi with unmapped reference targets: Device.

STU3: Claim.item.detail.subDetail.udi additional types from child elements (display, identifier, reference)

Element Claim.item.detail.subDetail.udi is mapped to FHIR R5 element Claim.item.detail.subDetail.udi as SourceIsBroaderThanTarget. The mappings for Claim.item.detail.subDetail.udi do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.item.detail.subDetail.udi with unmapped reference targets: Device.

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

The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

STU3: Claim.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Element Claim.meta is mapped to FHIR R5 element Claim.meta as SourceIsBroaderThanTarget. The mappings for Claim.meta do not cover the following types: Meta. The mappings for Claim.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

When the resource last changed - e.g. when the version changed.

This element is generally omitted in instances submitted in a PUT or POST. Instead, it is populated in the response instance and when retrieving information using a GET. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

The exact use of the source (and the possible implied Provenance.entity.role and agent.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. The source may correspond to Provenance.entity.what[x] or Provenance.agent.who[x], though it may be a more general or abstract reference.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Unless not suitable, these codes SHALL be taken from AllSecurityLabels
(extensible to http://hl7.org/fhir/ValueSet/security-labels|5.0.0)

Security Labels from the Healthcare Privacy and Security Classification System.

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

IETF language tag for a human language

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

STU3: Claim.text additional types (Narrative) additional types from child elements (div, status)

Element Claim.text is mapped to FHIR R5 element Claim.text as SourceIsBroaderThanTarget. The mappings for Claim.text do not cover the following types: Narrative. The mappings for Claim.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

The status of a resource narrative.

The actual narrative content, a stripped down version of XHTML.

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

An Extension

STU3: Claim.organization (new:Reference(Organization))

Element Claim.organization has a context of Claim based on following the parent source element upwards and mapping to Claim. Element Claim.organization has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: Claim.employmentImpacted (new:Period)

Element Claim.employmentImpacted has a context of Claim based on following the parent source element upwards and mapping to Claim. Element Claim.employmentImpacted has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

STU3: Claim.hospitalization (new:Period)

Element Claim.hospitalization has a context of Claim based on following the parent source element upwards and mapping to Claim. Element Claim.hospitalization has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

A unique identifier assigned to this claim.

Allows claims to be distinguished and referenced.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

STU3: Claim.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element Claim.identifier is mapped to FHIR R5 element Claim.identifier as SourceIsBroaderThanTarget. The mappings for Claim.identifier do not cover the following types: Identifier. The mappings for Claim.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

The purpose of this identifier.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Allows users to make use of identifiers when the identifier system is not known.

Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.

Identifier.system is always case sensitive.

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Time period during which identifier is/was valid for use.

Organization that issued/manages the identifier.

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.

Allows partners to uniquely identify components for tracking.

The status of the resource instance.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

A code specifying the state of the resource instance.

Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

The code system provides oral, pharmacy, vision, professional and institutional claim types. Those supported depends on the requirements of the jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction.

The type or discipline-style of the claim.

Claim type determine the general sets of business rules applied for information requirements and adjudication.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

STU3: Claim.type

Element Claim.type is mapped to FHIR R5 element Claim.type as Equivalent. Affects which fields and value sets are used.

A reference to a code defined by a terminology system.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Very often the text is the same as a displayName of one of the codings.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

A more granular claim typecode.

Some jurisdictions need a finer grained claim type for routing and adjudication.

A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided.

The codes SHALL be taken from Use
(required to http://hl7.org/fhir/ValueSet/claim-use|5.0.0)

The purpose of the Claim: predetermination, preauthorization, claim.

This element is required to understand the nature of the request for adjudication.

unique id for the element within a resource (for internal references)

An Extension

STU3: Claim.use

Element Claim.use is mapped to FHIR R5 element Claim.use as SourceIsBroaderThanTarget.

Primitive value for code

The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

STU3: Claim.patient additional types from child elements (display, identifier, reference)

Element Claim.patient is mapped to FHIR R5 element Claim.patient as SourceIsBroaderThanTarget. The mappings for Claim.patient do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.patient with unmapped reference targets: Patient.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The period for which charges are being submitted.

Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.

A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

STU3: Claim.billablePeriod additional types (Period) additional types from child elements (end, start)

Element Claim.billablePeriod is mapped to FHIR R5 element Claim.billablePeriod as SourceIsBroaderThanTarget. The mappings for Claim.billablePeriod do not cover the following types: Period. The mappings for Claim.billablePeriod do not cover the following types based on type expansion: end, start.

The start of the period. The boundary is inclusive.

If the low element is missing, the meaning is that the low boundary is not known.

The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

The end value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

The date this resource was created.

This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

Need to record a timestamp for use by both the recipient and the issuer.

Individual who created the claim, predetermination or preauthorization.

Some jurisdictions require the contact information for personnel completing claims.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

STU3: Claim.enterer additional types from child elements (display, identifier, reference)

Element Claim.enterer is mapped to FHIR R5 element Claim.enterer as SourceIsBroaderThanTarget. The mappings for Claim.enterer do not cover the following types based on type expansion: display, identifier, reference. The standard extension alternate-reference has been mapped as the representation of FHIR STU3 element Claim.enterer with unmapped reference targets: Practitioner.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The Insurer who is target of the request.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension