Union of http://hl7.org/fhir/us/eltss/StructureDefinition/Claim-eltss and http://hl7.org/fhir/us/eltss/StructureDefinition/Claim-eltss

This is the set of resources that conform to either of the profiles Claim_eltss (http://hl7.org/fhir/us/eltss/StructureDefinition/Claim-eltss) and Claim_eltss (http://hl7.org/fhir/us/eltss/StructureDefinition/Claim-eltss). E.g. what you have to deal with if you get resources conforming to one of them

Structure

Name	Flags	Card.	Type	Description & Constraints
Claim		0..*		Claim, Pre-determination or Pre-authorization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
meta	Σ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children
text		0..1	Narrative	Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier		0..*	Identifier	Business Identifier for claim ele-1: All FHIR elements must have a @value or children
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children
subType		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. ele-1: All FHIR elements must have a @value or children
patient	Σ	1..1	Reference(Patient_eltss | #sd-Patient-eltss-Patient-eltss)	The recipient of the products and services ele-1: All FHIR elements must have a @value or children
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	dateTime	Resource creation date ele-1: All FHIR elements must have a @value or children
enterer		0..1	Reference(Practitioner_eltss | eLTSS PractitionerRole Profile | #sd-Practitioner-eltss-Practitioner-eltss)	Author of the claim ele-1: All FHIR elements must have a @value or children
insurer	Σ	0..1	Reference(Organization)	Target ele-1: All FHIR elements must have a @value or children
provider	Σ	1..1	Reference(Practitioner_eltss | eLTSS PractitionerRole Profile | US Core Organization Profile | #sd-Practitioner-eltss-Practitioner-eltss)	Party responsible for the claim ele-1: All FHIR elements must have a @value or children
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred. ele-1: All FHIR elements must have a @value or children
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). ele-1: All FHIR elements must have a @value or children
related		0..*	BackboneElement	Prior or corollary claims ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
claim		0..1	Reference(Claim_eltss), Reference(Claim_eltss)	Reference to the related claim ele-1: All FHIR elements must have a @value or children
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. ele-1: All FHIR elements must have a @value or children
reference		0..1	Identifier	File or case reference ele-1: All FHIR elements must have a @value or children
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products ele-1: All FHIR elements must have a @value or children
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller ele-1: All FHIR elements must have a @value or children
payee		0..1	BackboneElement	Recipient of benefits payable ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	CodeableConcept	Category of recipient Binding: ?? (example): A code for the party to be reimbursed. ele-1: All FHIR elements must have a @value or children
party		0..1	Reference(Practitioner_eltss | eLTSS PractitionerRole Profile | US Core Organization Profile | Patient_eltss | eLTSS RelatedPerson Profile | #sd-Practitioner-eltss-Practitioner-eltss)	Recipient reference ele-1: All FHIR elements must have a @value or children
referral		0..1	Reference(ServiceRequest_eltss | #sd-ServiceRequest-eltss-ServiceRequest-eltss)	Treatment referral ele-1: All FHIR elements must have a @value or children
facility		0..1	Reference(Location_eltss | #sd-Location-eltss-Location-eltss)	Servicing facility ele-1: All FHIR elements must have a @value or children
careTeam		0..*	BackboneElement	Members of the care team ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Order of care team ele-1: All FHIR elements must have a @value or children
provider		1..1	Reference(Practitioner_eltss | eLTSS PractitionerRole Profile | US Core Organization Profile | #sd-Practitioner-eltss-Practitioner-eltss)	Practitioner or organization ele-1: All FHIR elements must have a @value or children
responsible		0..1	boolean	Indicator of the lead practitioner ele-1: All FHIR elements must have a @value or children
role		0..1	CodeableConcept	Function within the team Binding: ?? (example): The role codes for the care team members. ele-1: All FHIR elements must have a @value or children
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. ele-1: All FHIR elements must have a @value or children
supportingInfo		0..*	BackboneElement	Supporting information ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Information instance identifier ele-1: All FHIR elements must have a @value or children
category		1..1	CodeableConcept	Classification of the supplied information Binding: ?? (example): The valuset used for additional information category codes. ele-1: All FHIR elements must have a @value or children
code		0..1	CodeableConcept	Type of information Binding: ?? (example): The valuset used for additional information codes. ele-1: All FHIR elements must have a @value or children
timing[x]		0..1		When it occurred ele-1: All FHIR elements must have a @value or children
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided ele-1: All FHIR elements must have a @value or children
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	CodeableConcept	Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. ele-1: All FHIR elements must have a @value or children
diagnosis		0..*	BackboneElement	Pertinent diagnosis information ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Diagnosis instance identifier ele-1: All FHIR elements must have a @value or children
diagnosis[x]		1..1		Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. ele-1: All FHIR elements must have a @value or children
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. ele-1: All FHIR elements must have a @value or children
onAdmission		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission. ele-1: All FHIR elements must have a @value or children
packageCode		0..1	CodeableConcept	Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. ele-1: All FHIR elements must have a @value or children
procedure		0..*	BackboneElement	Clinical procedures performed ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Procedure instance identifier ele-1: All FHIR elements must have a @value or children
type		0..*	CodeableConcept	Category of Procedure Binding: ?? (example): Example procedure type codes. ele-1: All FHIR elements must have a @value or children
date		0..1	dateTime	When the procedure was performed ele-1: All FHIR elements must have a @value or children
procedure[x]		1..1		Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. ele-1: All FHIR elements must have a @value or children
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
insurance	Σ	1..*	BackboneElement	Patient insurance information ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence	Σ	1..1	positiveInt	Insurance instance identifier ele-1: All FHIR elements must have a @value or children
focal	Σ	1..1	boolean	Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children
identifier		0..1	Identifier	Pre-assigned Claim number ele-1: All FHIR elements must have a @value or children
coverage	Σ	1..1	Reference(Coverage)	Insurance information ele-1: All FHIR elements must have a @value or children
businessArrangement		0..1	string	Additional provider contract number ele-1: All FHIR elements must have a @value or children
preAuthRef		0..*	string	Prior authorization reference number ele-1: All FHIR elements must have a @value or children
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results ele-1: All FHIR elements must have a @value or children
accident		0..1	BackboneElement	Details of the event ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
date		1..1	date	When the incident occurred ele-1: All FHIR elements must have a @value or children
type		0..1	CodeableConcept	The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. ele-1: All FHIR elements must have a @value or children
location[x]		0..1		Where the event occurred ele-1: All FHIR elements must have a @value or children
locationAddress			Address
locationReference			Reference(Location)
item	S	0..*	BackboneElement	Product or service provided ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Item instance identifier ele-1: All FHIR elements must have a @value or children
careTeamSequence		0..*	positiveInt	Applicable careTeam members ele-1: All FHIR elements must have a @value or children
diagnosisSequence		0..*	positiveInt	Applicable diagnoses ele-1: All FHIR elements must have a @value or children
procedureSequence		0..*	positiveInt	Applicable procedures ele-1: All FHIR elements must have a @value or children
informationSequence		0..*	positiveInt	Applicable exception and supporting information ele-1: All FHIR elements must have a @value or children
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. ele-1: All FHIR elements must have a @value or children
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ?? (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. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
serviced[x]		0..1		Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. ele-1: All FHIR elements must have a @value or children
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice	S	0..1	Money	Service Rate per Unit name ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net	S	0..1	Money	Total Cost of Service ele-1: All FHIR elements must have a @value or children
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. ele-1: All FHIR elements must have a @value or children
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. ele-1: All FHIR elements must have a @value or children
encounter		0..*	Reference(Encounter)	Encounters related to this billed item ele-1: All FHIR elements must have a @value or children
detail		0..*	BackboneElement	Product or service provided ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Item instance identifier ele-1: All FHIR elements must have a @value or children
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. ele-1: All FHIR elements must have a @value or children
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (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. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
subDetail		0..*	BackboneElement	Product or service provided ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Item instance identifier ele-1: All FHIR elements must have a @value or children
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. ele-1: All FHIR elements must have a @value or children
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (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. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
total		0..1	Money	Total claim cost ele-1: All FHIR elements must have a @value or children
Documentation for this format