-
-
Key: = Must support, = QICore-defined extension, = Is-Modifier
Field Card. Type and Description 
accident 0..1AccidentAn accident which resulted in the need for healthcare services.billablePeriod 0..1Interval<DateTime>The billable period for which charges are being submitted.careTeam 0..*List<CareTeam>The members of the team who provided the overall service as well as their role and whether responsible and qualifications.created 1..1DateTimeThe date when the enclosed suite of services were performed or completed.diagnosis 0..*List<Diagnosis>List of patient diagnosis for which care is sought.employmentImpacted 0..1Interval<DateTime>The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).enterer 0..1ReferencePerson who created the invoice/claim/pre-determination or pre-authorization.facility 0..1ReferenceFacility where the services were provided.fundsReserve 0..1ConceptIn the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.Binding: Funds Reservation Codes (Example)
hospitalization 0..1Interval<DateTime>Period in hospital.identifier 0..*List<Identifier>The business identifier for the instance: claim number, pre-determination or pre-authorization number.information 0..*List<Information>Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.insurance 0..*List<Insurance>Financial instrument by which payment information for health care.insurer 0..1ReferenceThe Insurer who is target of the request.item 1..*List<Item>First tier of goods and services.organization 0..1ReferenceThe organization which is responsible for the bill, claim pre-determination, pre-authorization.originalPrescription 0..1ReferenceOriginal prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.patient 1..1ReferencePatient Resource.payee 0..1PayeeThe party to be reimbursed for the services.prescription 1..1ReferencePrescription to support the dispensing of Pharmacy or Vision products.priority 0..1ConceptImmediate (STAT), best effort (NORMAL), deferred (DEFER).Binding: Process Priority Codes (Example)
procedure 0..*List<Procedure>Procedures performed.provider 1..1ReferenceThe provider which is responsible for the bill, claim pre-determination, pre-authorization.referral 0..1ReferenceThe referral resource which lists the date, practitioner, reason and other supporting information.related 0..*List<Related>Other claims which are related to this claim such as prior claim versions or for related services.status 0..1StringThe status of the resource instance.Binding: Financial Resource Status Codes (Required)
subType 0..*List<Concept>A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.Binding: Example Claim SubType Codes (Example)
total 0..1MoneyThe total value of the claim.type 0..1ConceptThe category of claim, eg, oral, pharmacy, vision, insitutional, professional.Binding: Example Claim Type Codes (Required)
use 0..1StringComplete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).Binding: Use (Required)
Key: = Must support, = QICore-defined extension, = Is-Modifier
-