0.1.0 - ci-build

kenyaClaimsIG - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: ClaimInstitutionalProfile

Official URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/ClaimInstitutionalProfile Version: 0.1.0
Draft as of 2024-09-06 Computable Name: ClaimInstitutionalProfile

FHIR Profile for Authorization - Institutional Claim

Usage:

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

Formal Views of Profile Content

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

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id 1..1 id Unique string for reference purposes
... meta 1..1 Meta Metadata about a resource
.... profile 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
.... batchIdentifier 0..1 Identifier Extension for Batch Identifier
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-identifier
.... batchNumber 0..1 string Extension for Batch Number
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-number
.... batchPeriod 0..1 string Extension for Batch Period
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-period
.... diagnosisRelatedGroup 0..1 CodeableConcept Extension for Diagnosis Related Group
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/diagnosis-related-group
.... encounter 0..1 Reference(Encounter) ClaimAuthorizationInstitutionalProfileEncounter
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/claim-authorization-institutional-profile-encounter
.... eligibilityResponse 0..1 Reference(SHACoverageEligibilityResponse) EligibilityResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-response
.... EligibilityOffline 0..1 string Extension for EligibilityOffline
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline
.... EligibilityOfflineDate 0..1 date Extension for Eligibility OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline-date
.... authorizationOffLineDate 0..1 date Extension for authorization OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/authorization-offLine-date
.... priorAuthResponse 0..1 Reference(ClaimResponse | ClaimResponseAuthorizationResponseProfile) PriorAuthResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/prior-auth-response
.... episode 0..1 Identifier Extension for Episode
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/episode
.... newborn 0..1 boolean Extension for Newborn
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/newborn
.... package 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
... identifier 1..1 Identifier A unique identifier assigned to this claim.
... status 1..1 code The status of the resource instance.
... type 1..1 CodeableConcept The category of authorization
... subType 1..1 CodeableConcept A finer-grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
... use 1..1 code A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
... patient 1..1 Reference(SHAPatient) 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.
... billablePeriod 0..1 Period The period for which charges are being submitted.
... created 1..1 dateTime The date this resource was created.
... insurer 1..1 Reference(Organization) The Insurer who is target of the request.
... provider 1..1 Reference(SHAOrganization | SHAPractitioner) The provider which is responsible for the claim, predetermination or preauthorization.
... priority 1..1 CodeableConcept The provider-required urgency of processing the request. Typical values include: stat, normal (routine), deferred.
... fundsReserve 0..1 CodeableConcept A code to indicate whether and for whom funds are to be reserved for future claims.
... related 0..* BackboneElement Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
.... claim 1..1 Reference(Claim) Reference to a related claim.
.... relationship 1..1 CodeableConcept A code to convey how the claims are related.
... prescription 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription to support the dispensing of pharmacy, device or vision products.
... originalPrescription 0..1 Reference(MedicationRequest) Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
... payee 1..1 BackboneElement The party to be reimbursed for cost of the products and services according to the terms of the policy.
.... type 1..1 CodeableConcept Type of Party to be reimbursed: subscriber, provider, other.
.... party 0..1 Reference(SHAOrganization | SHAPractitioner | SHAPatient) Party to be reimbursed.
... referral 0..1 Reference(ServiceRequest) A reference to a referral resource.
... facility 0..1 Reference(Location) Facility where the services were provided.
... careTeam 1..* BackboneElement The members of the team who provided the products and services.
.... sequence 1..1 positiveInt A number to uniquely identify care team entries.
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Member of the team who provided the product or service.
.... role 1..1 CodeableConcept The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
.... qualification 1..1 CodeableConcept The qualification of the practitioner which is applicable for this service.
... supportingInfo 0..* BackboneElement Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
.... sequence 1..1 positiveInt A number to uniquely identify supporting information entries.
.... category 1..1 CodeableConcept The general class of the information supplied: information; exception; accident, employment; onset, etc.
.... code 0..1 CodeableConcept System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
.... Slices for timing[x] 0..1 date, Period When it occurred
Slice: Unordered, Open by type:$this
..... timing[x]:timingDate 0..1 date The date when or period to which this information refers.
..... timing[x]:timingPeriod 0..1 Period The period when or period to which this information refers.
.... Slices for value[x] 0..1 boolean, string, Quantity, Attachment, Reference(Resource) Data to be provided
Slice: Unordered, Open by type:$this
..... value[x]:valueBoolean 0..1 boolean Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueString 0..1 string Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueQuantity 0..1 Quantity Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueAttachment 0..1 Attachment Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueReference 0..1 Reference(Resource) A reference, either FHIR resource reference or the business identifier of an information object, for example a document in an external repository.
.... reason 0..1 CodeableConcept Provides the reason in the situation where a reason code is required in addition to the content.
... diagnosis 1..* BackboneElement Information about diagnoses relevant to the claim items.
.... sequence 1..1 positiveInt A number to uniquely identify diagnosis entries.
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Open by type:$this
..... diagnosis[x]:diagnosisCodeableConcept 1..1 CodeableConcept The diagnosis code.
.... type 1..1 CodeableConcept When the condition was observed or the relative ranking.
.... onAdmission 0..1 CodeableConcept Indication of whether the diagnosis was present on admission to a facility.
... insurance 1..* BackboneElement Insurance information.
.... sequence 1..1 positiveInt A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
.... focal 1..1 boolean A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
.... coverage 1..1 Reference(Coverage) Reference to the insurance card level information contained in the Coverage resource.
.... preAuthRef 0..* string Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
.... claimResponse 0..1 Reference(ClaimResponse) The result of the adjudication of the line items for the Coverage specified in this insurance.
... accident 0..1 BackboneElement Details of an accident which resulted in injuries which required the products and services listed in the claim.
.... date 1..1 date Date of an accident event related to the products and services contained in the claim.
.... type 1..1 CodeableConcept The type or context of the accident event for the purposes
.... Slices for location[x] 0..1 Address, Reference(Location) Where the event occurred
Slice: Unordered, Open by type:$this
..... location[x]:locationAddress 0..1 Address The physical location of the accident event.
... item 1..* BackboneElement A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
.... Slices for extension 3..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
..... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... itemPayerShare 1..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... itemPatientShare 1..1 Money Extension for Patient Share
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-share
..... itemPatientInvoice 1..1 Identifier Extension for Patient Invoice
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-invoice
.... sequence 1..1 positiveInt A number to uniquely identify item entries.
.... careTeamSequence 1..* positiveInt CareTeam members related to this service or product.
.... diagnosisSequence 0..* positiveInt Diagnosis applicable for this service or product.
.... informationSequence 0..* positiveInt Exceptions, special conditions and supporting information applicable for this service or product.
.... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
.... Slices for serviced[x] 0..1 date, Period Date or dates of service or product delivery
Slice: Unordered, Open by type:$this
..... serviced[x]:servicedDate 0..1 date The date or dates when the service or product was supplied, performed or completed.
..... serviced[x]:servicedPeriod 0..1 Period The period when the service or product was supplied, performed or completed.
.... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
.... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
.... factor 0..1 decimal A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received.
.... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
.... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
.... bodySite 0..1 CodeableConcept Physical service site on the patient (limb, tooth, etc.).
.... subSite 0..1 CodeableConcept A region or surface of the bodySite, e.g. limb region or tooth surface(s).
.... detail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
..... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
...... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... sequence 1..1 positiveInt A number to uniquely identify item entries.
..... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
..... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
..... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
..... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
..... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
..... subDetail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
...... sequence 1..1 positiveInt A number to uniquely identify item entries.
...... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
...... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
...... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
...... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
...... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
... total 1..1 Money The total value of all the items in the claim.

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 1..1 id Unique string for reference purposes
... meta Σ 1..1 Meta Metadata about a resource
.... profile Σ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
.... batchIdentifier 0..1 Identifier Extension for Batch Identifier
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-identifier
.... batchNumber 0..1 string Extension for Batch Number
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-number
.... batchPeriod 0..1 string Extension for Batch Period
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-period
.... diagnosisRelatedGroup 0..1 CodeableConcept Extension for Diagnosis Related Group
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/diagnosis-related-group
.... encounter 0..1 Reference(Encounter) ClaimAuthorizationInstitutionalProfileEncounter
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/claim-authorization-institutional-profile-encounter
.... eligibilityResponse 0..1 Reference(SHACoverageEligibilityResponse) EligibilityResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-response
.... EligibilityOffline 0..1 string Extension for EligibilityOffline
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline
.... EligibilityOfflineDate 0..1 date Extension for Eligibility OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline-date
.... authorizationOffLineDate 0..1 date Extension for authorization OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/authorization-offLine-date
.... priorAuthResponse 0..1 Reference(ClaimResponse | ClaimResponseAuthorizationResponseProfile) PriorAuthResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/prior-auth-response
.... episode 0..1 Identifier Extension for Episode
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/episode
.... newborn 0..1 boolean Extension for Newborn
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/newborn
.... package 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 1..1 Identifier A unique identifier assigned to this claim.
... status ?!Σ 1..1 code The status of the resource instance.
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept The category of authorization
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType 1..1 CodeableConcept A finer-grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ 1..1 code A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient Σ 1..1 Reference(SHAPatient) 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.
... billablePeriod Σ 0..1 Period The period for which charges are being submitted.
... created Σ 1..1 dateTime The date this resource was created.
... insurer Σ 1..1 Reference(Organization) The Insurer who is target of the request.
... provider Σ 1..1 Reference(SHAOrganization | SHAPractitioner) The provider which is responsible for the claim, predetermination or preauthorization.
... priority Σ 1..1 CodeableConcept The provider-required urgency of processing the request. Typical values include: stat, normal (routine), deferred.
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... fundsReserve 0..1 CodeableConcept A code to indicate whether and for whom funds are to be reserved for future claims.
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..* BackboneElement Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 1..1 Reference(Claim) Reference to a related claim.
.... relationship 1..1 CodeableConcept A code to convey how the claims are related.
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

... prescription 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription to support the dispensing of pharmacy, device or vision products.
... originalPrescription 0..1 Reference(MedicationRequest) Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
... payee 1..1 BackboneElement The party to be reimbursed for cost of the products and services according to the terms of the policy.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of Party to be reimbursed: subscriber, provider, other.
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(SHAOrganization | SHAPractitioner | SHAPatient) Party to be reimbursed.
... referral 0..1 Reference(ServiceRequest) A reference to a referral resource.
... facility 0..1 Reference(Location) Facility where the services were provided.
... careTeam 1..* BackboneElement The members of the team who provided the products and services.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify care team entries.
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Member of the team who provided the product or service.
.... role 1..1 CodeableConcept The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 1..1 CodeableConcept The qualification of the practitioner which is applicable for this service.
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo 0..* BackboneElement Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify supporting information entries.
.... category 1..1 CodeableConcept The general class of the information supplied: information; exception; accident, employment; onset, etc.
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code 0..1 CodeableConcept System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... Slices for timing[x] 0..1 When it occurred
Slice: Unordered, Closed by type:$this
..... timingDate date
..... timingPeriod Period
..... timing[x]:timingDate 0..1 date The date when or period to which this information refers.
..... timing[x]:timingPeriod 0..1 Period The period when or period to which this information refers.
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Closed by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueBoolean 0..1 boolean Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueString 0..1 string Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueQuantity 0..1 Quantity Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueAttachment 0..1 Attachment Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueReference 0..1 Reference(Resource) A reference, either FHIR resource reference or the business identifier of an information object, for example a document in an external repository.
.... reason 0..1 CodeableConcept Provides the reason in the situation where a reason code is required in addition to the content.
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis 1..* BackboneElement Information about diagnoses relevant to the claim items.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify diagnosis entries.
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosis[x]:diagnosisCodeableConcept 1..1 CodeableConcept The diagnosis code.
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

.... type 1..1 CodeableConcept When the condition was observed or the relative ranking.
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission 0..1 CodeableConcept Indication of whether the diagnosis was present on admission to a facility.
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

... insurance Σ 1..* BackboneElement Insurance information.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
.... focal Σ 1..1 boolean A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
.... coverage Σ 1..1 Reference(Coverage) Reference to the insurance card level information contained in the Coverage resource.
.... preAuthRef 0..* string Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
.... claimResponse 0..1 Reference(ClaimResponse) The result of the adjudication of the line items for the Coverage specified in this insurance.
... accident 0..1 BackboneElement Details of an accident which resulted in injuries which required the products and services listed in the claim.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date Date of an accident event related to the products and services contained in the claim.
.... type 1..1 CodeableConcept The type or context of the accident event for the purposes
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... Slices for location[x] 0..1 Where the event occurred
Slice: Unordered, Open by type:$this
..... locationAddress Address
..... locationReference Reference(Location)
..... location[x]:locationAddress 0..1 Address The physical location of the accident event.
... item 1..* BackboneElement A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
.... Slices for extension 3..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
..... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... itemPayerShare 1..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... itemPatientShare 1..1 Money Extension for Patient Share
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-share
..... itemPatientInvoice 1..1 Identifier Extension for Patient Invoice
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-invoice
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify item entries.
.... careTeamSequence 1..* positiveInt CareTeam members related to this service or product.
.... diagnosisSequence 0..* positiveInt Diagnosis applicable for this service or product.
.... informationSequence 0..* positiveInt Exceptions, special conditions and supporting information applicable for this service or product.
.... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
Binding: USCLSCodes (example): Allowable service and product codes.

.... Slices for serviced[x] 0..1 Date or dates of service or product delivery
Slice: Unordered, Closed by type:$this
..... servicedDate date
..... servicedPeriod Period
..... serviced[x]:servicedDate 0..1 date The date or dates when the service or product was supplied, performed or completed.
..... serviced[x]:servicedPeriod 0..1 Period The period when the service or product was supplied, performed or completed.
.... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
.... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
.... factor 0..1 decimal A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received.
.... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
.... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
.... bodySite 0..1 CodeableConcept Physical service site on the patient (limb, tooth, etc.).
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..1 CodeableConcept A region or surface of the bodySite, e.g. limb region or tooth surface(s).
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... detail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
..... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
...... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt A number to uniquely identify item entries.
..... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
Binding: USCLSCodes (example): Allowable service and product codes.

..... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
..... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
..... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
..... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
..... subDetail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt A number to uniquely identify item entries.
...... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
Binding: USCLSCodes (example): Allowable service and product codes.

...... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
...... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
...... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
...... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
... total 1..1 Money The total value of all the items in the claim.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensibleClaimTypeCodes
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.subTypeexampleExampleClaimSubTypeCodes
http://hl7.org/fhir/ValueSet/claim-subtype
from the FHIR Standard
Claim.userequiredUse
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityexampleProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.fundsReserveexampleFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConceptexampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.bodySiteexampleOralSiteCodes
http://hl7.org/fhir/ValueSet/tooth
from the FHIR Standard
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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 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(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 1..1 id Unique string for reference purposes
... meta Σ 1..1 Meta Metadata about a resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... 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 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... 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): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
.... batchIdentifier 0..1 Identifier Extension for Batch Identifier
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-identifier
.... batchNumber 0..1 string Extension for Batch Number
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-number
.... batchPeriod 0..1 string Extension for Batch Period
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-period
.... diagnosisRelatedGroup 0..1 CodeableConcept Extension for Diagnosis Related Group
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/diagnosis-related-group
.... encounter 0..1 Reference(Encounter) ClaimAuthorizationInstitutionalProfileEncounter
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/claim-authorization-institutional-profile-encounter
.... eligibilityResponse 0..1 Reference(SHACoverageEligibilityResponse) EligibilityResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-response
.... EligibilityOffline 0..1 string Extension for EligibilityOffline
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline
.... EligibilityOfflineDate 0..1 date Extension for Eligibility OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline-date
.... authorizationOffLineDate 0..1 date Extension for authorization OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/authorization-offLine-date
.... priorAuthResponse 0..1 Reference(ClaimResponse | ClaimResponseAuthorizationResponseProfile) PriorAuthResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/prior-auth-response
.... episode 0..1 Identifier Extension for Episode
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/episode
.... newborn 0..1 boolean Extension for Newborn
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/newborn
.... package 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 1..1 Identifier A unique identifier assigned to this claim.
... status ?!Σ 1..1 code The status of the resource instance.
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept The category of authorization
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType 1..1 CodeableConcept A finer-grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ 1..1 code A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient Σ 1..1 Reference(SHAPatient) 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.
... billablePeriod Σ 0..1 Period The period for which charges are being submitted.
... created Σ 1..1 dateTime The date this resource was created.
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 1..1 Reference(Organization) The Insurer who is target of the request.
... provider Σ 1..1 Reference(SHAOrganization | SHAPractitioner) The provider which is responsible for the claim, predetermination or preauthorization.
... priority Σ 1..1 CodeableConcept The provider-required urgency of processing the request. Typical values include: stat, normal (routine), deferred.
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... fundsReserve 0..1 CodeableConcept A code to indicate whether and for whom funds are to be reserved for future claims.
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..* BackboneElement Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 1..1 Reference(Claim) Reference to a related claim.
.... relationship 1..1 CodeableConcept A code to convey how the claims are related.
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription to support the dispensing of pharmacy, device or vision products.
... originalPrescription 0..1 Reference(MedicationRequest) Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
... payee 1..1 BackboneElement The party to be reimbursed for cost of the products and services according to the terms of the policy.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of Party to be reimbursed: subscriber, provider, other.
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(SHAOrganization | SHAPractitioner | SHAPatient) Party to be reimbursed.
... referral 0..1 Reference(ServiceRequest) A reference to a referral resource.
... facility 0..1 Reference(Location) Facility where the services were provided.
... careTeam 1..* BackboneElement The members of the team who provided the products and services.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify care team entries.
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Member of the team who provided the product or service.
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 1..1 CodeableConcept The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 1..1 CodeableConcept The qualification of the practitioner which is applicable for this service.
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo 0..* BackboneElement Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify supporting information entries.
.... category 1..1 CodeableConcept The general class of the information supplied: information; exception; accident, employment; onset, etc.
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code 0..1 CodeableConcept System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... Slices for timing[x] 0..1 When it occurred
Slice: Unordered, Closed by type:$this
..... timingDate date
..... timingPeriod Period
..... timing[x]:timingDate 0..1 date The date when or period to which this information refers.
..... timing[x]:timingPeriod 0..1 Period The period when or period to which this information refers.
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Closed by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueBoolean 0..1 boolean Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueString 0..1 string Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueQuantity 0..1 Quantity Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueAttachment 0..1 Attachment Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueReference 0..1 Reference(Resource) A reference, either FHIR resource reference or the business identifier of an information object, for example a document in an external repository.
.... reason 0..1 CodeableConcept Provides the reason in the situation where a reason code is required in addition to the content.
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis 1..* BackboneElement Information about diagnoses relevant to the claim items.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify diagnosis entries.
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosis[x]:diagnosisCodeableConcept 1..1 CodeableConcept The diagnosis code.
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

.... type 1..1 CodeableConcept When the condition was observed or the relative ranking.
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission 0..1 CodeableConcept Indication of whether the diagnosis was present on admission to a facility.
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
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Insurance information.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
.... focal Σ 1..1 boolean A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(Coverage) Reference to the insurance card level information contained in the Coverage resource.
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
.... claimResponse 0..1 Reference(ClaimResponse) The result of the adjudication of the line items for the Coverage specified in this insurance.
... accident 0..1 BackboneElement Details of an accident which resulted in injuries which required the products and services listed in the claim.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date Date of an accident event related to the products and services contained in the claim.
.... type 1..1 CodeableConcept The type or context of the accident event for the purposes
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... Slices for location[x] 0..1 Where the event occurred
Slice: Unordered, Open by type:$this
..... locationAddress Address
..... locationReference Reference(Location)
..... location[x]:locationAddress 0..1 Address The physical location of the accident event.
... item 1..* BackboneElement A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 3..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
..... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... itemPayerShare 1..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... itemPatientShare 1..1 Money Extension for Patient Share
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-share
..... itemPatientInvoice 1..1 Identifier Extension for Patient Invoice
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-invoice
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify item entries.
.... careTeamSequence 1..* positiveInt CareTeam members related to this service or product.
.... diagnosisSequence 0..* positiveInt Diagnosis applicable for this service or product.
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Exceptions, special conditions and supporting information applicable for this service or product.
.... 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 When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
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.


.... Slices for serviced[x] 0..1 Date or dates of service or product delivery
Slice: Unordered, Closed by type:$this
..... servicedDate date
..... servicedPeriod Period
..... serviced[x]:servicedDate 0..1 date The date or dates when the service or product was supplied, performed or completed.
..... serviced[x]:servicedPeriod 0..1 Period The period when the service or product was supplied, performed or completed.
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
.... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
.... factor 0..1 decimal A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received.
.... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
.... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
.... bodySite 0..1 CodeableConcept Physical service site on the patient (limb, tooth, etc.).
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..1 CodeableConcept A region or surface of the bodySite, e.g. limb region or tooth surface(s).
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
...... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt A number to uniquely identify item entries.
..... 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 When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
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 1..1 SimpleQuantity The number of repetitions of a service or product.
..... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
..... factor 0..1 decimal Price scaling factor
..... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
..... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
..... subDetail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
...... id 0..1 string Unique id for inter-element referencing
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt A number to uniquely identify item entries.
...... 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 When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
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 1..1 SimpleQuantity The number of repetitions of a service or product.
...... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
...... factor 0..1 decimal Price scaling factor
...... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
...... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
... total 1..1 Money The total value of all the items in the claim.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Claim.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Claim.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensibleClaimTypeCodes
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.subTypeexampleExampleClaimSubTypeCodes
http://hl7.org/fhir/ValueSet/claim-subtype
from the FHIR Standard
Claim.userequiredUse
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityexampleProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.fundsReserveexampleFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConceptexampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.procedure.typeexampleExampleProcedureTypeCodes
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
http://hl7.org/fhir/ValueSet/icd-10-procedures
from the FHIR Standard
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
from the FHIR Standard
Claim.item.bodySiteexampleOralSiteCodes
http://hl7.org/fhir/ValueSet/tooth
from the FHIR Standard
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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 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(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Claim

Summary

Mandatory: 22 elements(9 nested mandatory elements)

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.supportingInfo.timing[x]
  • The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
  • The element 1 is sliced based on the value of Claim.diagnosis.diagnosis[x]
  • The element 1 is sliced based on the value of Claim.accident.location[x]
  • The element 1 is sliced based on the value of Claim.item.serviced[x]

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id 1..1 id Unique string for reference purposes
... meta 1..1 Meta Metadata about a resource
.... profile 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
.... batchIdentifier 0..1 Identifier Extension for Batch Identifier
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-identifier
.... batchNumber 0..1 string Extension for Batch Number
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-number
.... batchPeriod 0..1 string Extension for Batch Period
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-period
.... diagnosisRelatedGroup 0..1 CodeableConcept Extension for Diagnosis Related Group
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/diagnosis-related-group
.... encounter 0..1 Reference(Encounter) ClaimAuthorizationInstitutionalProfileEncounter
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/claim-authorization-institutional-profile-encounter
.... eligibilityResponse 0..1 Reference(SHACoverageEligibilityResponse) EligibilityResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-response
.... EligibilityOffline 0..1 string Extension for EligibilityOffline
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline
.... EligibilityOfflineDate 0..1 date Extension for Eligibility OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline-date
.... authorizationOffLineDate 0..1 date Extension for authorization OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/authorization-offLine-date
.... priorAuthResponse 0..1 Reference(ClaimResponse | ClaimResponseAuthorizationResponseProfile) PriorAuthResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/prior-auth-response
.... episode 0..1 Identifier Extension for Episode
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/episode
.... newborn 0..1 boolean Extension for Newborn
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/newborn
.... package 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
... identifier 1..1 Identifier A unique identifier assigned to this claim.
... status 1..1 code The status of the resource instance.
... type 1..1 CodeableConcept The category of authorization
... subType 1..1 CodeableConcept A finer-grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
... use 1..1 code A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
... patient 1..1 Reference(SHAPatient) 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.
... billablePeriod 0..1 Period The period for which charges are being submitted.
... created 1..1 dateTime The date this resource was created.
... insurer 1..1 Reference(Organization) The Insurer who is target of the request.
... provider 1..1 Reference(SHAOrganization | SHAPractitioner) The provider which is responsible for the claim, predetermination or preauthorization.
... priority 1..1 CodeableConcept The provider-required urgency of processing the request. Typical values include: stat, normal (routine), deferred.
... fundsReserve 0..1 CodeableConcept A code to indicate whether and for whom funds are to be reserved for future claims.
... related 0..* BackboneElement Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
.... claim 1..1 Reference(Claim) Reference to a related claim.
.... relationship 1..1 CodeableConcept A code to convey how the claims are related.
... prescription 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription to support the dispensing of pharmacy, device or vision products.
... originalPrescription 0..1 Reference(MedicationRequest) Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
... payee 1..1 BackboneElement The party to be reimbursed for cost of the products and services according to the terms of the policy.
.... type 1..1 CodeableConcept Type of Party to be reimbursed: subscriber, provider, other.
.... party 0..1 Reference(SHAOrganization | SHAPractitioner | SHAPatient) Party to be reimbursed.
... referral 0..1 Reference(ServiceRequest) A reference to a referral resource.
... facility 0..1 Reference(Location) Facility where the services were provided.
... careTeam 1..* BackboneElement The members of the team who provided the products and services.
.... sequence 1..1 positiveInt A number to uniquely identify care team entries.
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Member of the team who provided the product or service.
.... role 1..1 CodeableConcept The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
.... qualification 1..1 CodeableConcept The qualification of the practitioner which is applicable for this service.
... supportingInfo 0..* BackboneElement Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
.... sequence 1..1 positiveInt A number to uniquely identify supporting information entries.
.... category 1..1 CodeableConcept The general class of the information supplied: information; exception; accident, employment; onset, etc.
.... code 0..1 CodeableConcept System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
.... Slices for timing[x] 0..1 date, Period When it occurred
Slice: Unordered, Open by type:$this
..... timing[x]:timingDate 0..1 date The date when or period to which this information refers.
..... timing[x]:timingPeriod 0..1 Period The period when or period to which this information refers.
.... Slices for value[x] 0..1 boolean, string, Quantity, Attachment, Reference(Resource) Data to be provided
Slice: Unordered, Open by type:$this
..... value[x]:valueBoolean 0..1 boolean Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueString 0..1 string Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueQuantity 0..1 Quantity Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueAttachment 0..1 Attachment Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueReference 0..1 Reference(Resource) A reference, either FHIR resource reference or the business identifier of an information object, for example a document in an external repository.
.... reason 0..1 CodeableConcept Provides the reason in the situation where a reason code is required in addition to the content.
... diagnosis 1..* BackboneElement Information about diagnoses relevant to the claim items.
.... sequence 1..1 positiveInt A number to uniquely identify diagnosis entries.
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Open by type:$this
..... diagnosis[x]:diagnosisCodeableConcept 1..1 CodeableConcept The diagnosis code.
.... type 1..1 CodeableConcept When the condition was observed or the relative ranking.
.... onAdmission 0..1 CodeableConcept Indication of whether the diagnosis was present on admission to a facility.
... insurance 1..* BackboneElement Insurance information.
.... sequence 1..1 positiveInt A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
.... focal 1..1 boolean A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
.... coverage 1..1 Reference(Coverage) Reference to the insurance card level information contained in the Coverage resource.
.... preAuthRef 0..* string Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
.... claimResponse 0..1 Reference(ClaimResponse) The result of the adjudication of the line items for the Coverage specified in this insurance.
... accident 0..1 BackboneElement Details of an accident which resulted in injuries which required the products and services listed in the claim.
.... date 1..1 date Date of an accident event related to the products and services contained in the claim.
.... type 1..1 CodeableConcept The type or context of the accident event for the purposes
.... Slices for location[x] 0..1 Address, Reference(Location) Where the event occurred
Slice: Unordered, Open by type:$this
..... location[x]:locationAddress 0..1 Address The physical location of the accident event.
... item 1..* BackboneElement A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
.... Slices for extension 3..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
..... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... itemPayerShare 1..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... itemPatientShare 1..1 Money Extension for Patient Share
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-share
..... itemPatientInvoice 1..1 Identifier Extension for Patient Invoice
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-invoice
.... sequence 1..1 positiveInt A number to uniquely identify item entries.
.... careTeamSequence 1..* positiveInt CareTeam members related to this service or product.
.... diagnosisSequence 0..* positiveInt Diagnosis applicable for this service or product.
.... informationSequence 0..* positiveInt Exceptions, special conditions and supporting information applicable for this service or product.
.... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
.... Slices for serviced[x] 0..1 date, Period Date or dates of service or product delivery
Slice: Unordered, Open by type:$this
..... serviced[x]:servicedDate 0..1 date The date or dates when the service or product was supplied, performed or completed.
..... serviced[x]:servicedPeriod 0..1 Period The period when the service or product was supplied, performed or completed.
.... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
.... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
.... factor 0..1 decimal A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received.
.... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
.... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
.... bodySite 0..1 CodeableConcept Physical service site on the patient (limb, tooth, etc.).
.... subSite 0..1 CodeableConcept A region or surface of the bodySite, e.g. limb region or tooth surface(s).
.... detail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
..... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
...... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... sequence 1..1 positiveInt A number to uniquely identify item entries.
..... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
..... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
..... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
..... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
..... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
..... subDetail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
...... sequence 1..1 positiveInt A number to uniquely identify item entries.
...... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
...... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
...... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
...... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
...... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
... total 1..1 Money The total value of all the items in the claim.

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 1..1 id Unique string for reference purposes
... meta Σ 1..1 Meta Metadata about a resource
.... profile Σ 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
.... batchIdentifier 0..1 Identifier Extension for Batch Identifier
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-identifier
.... batchNumber 0..1 string Extension for Batch Number
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-number
.... batchPeriod 0..1 string Extension for Batch Period
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-period
.... diagnosisRelatedGroup 0..1 CodeableConcept Extension for Diagnosis Related Group
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/diagnosis-related-group
.... encounter 0..1 Reference(Encounter) ClaimAuthorizationInstitutionalProfileEncounter
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/claim-authorization-institutional-profile-encounter
.... eligibilityResponse 0..1 Reference(SHACoverageEligibilityResponse) EligibilityResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-response
.... EligibilityOffline 0..1 string Extension for EligibilityOffline
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline
.... EligibilityOfflineDate 0..1 date Extension for Eligibility OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline-date
.... authorizationOffLineDate 0..1 date Extension for authorization OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/authorization-offLine-date
.... priorAuthResponse 0..1 Reference(ClaimResponse | ClaimResponseAuthorizationResponseProfile) PriorAuthResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/prior-auth-response
.... episode 0..1 Identifier Extension for Episode
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/episode
.... newborn 0..1 boolean Extension for Newborn
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/newborn
.... package 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 1..1 Identifier A unique identifier assigned to this claim.
... status ?!Σ 1..1 code The status of the resource instance.
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept The category of authorization
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType 1..1 CodeableConcept A finer-grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ 1..1 code A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient Σ 1..1 Reference(SHAPatient) 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.
... billablePeriod Σ 0..1 Period The period for which charges are being submitted.
... created Σ 1..1 dateTime The date this resource was created.
... insurer Σ 1..1 Reference(Organization) The Insurer who is target of the request.
... provider Σ 1..1 Reference(SHAOrganization | SHAPractitioner) The provider which is responsible for the claim, predetermination or preauthorization.
... priority Σ 1..1 CodeableConcept The provider-required urgency of processing the request. Typical values include: stat, normal (routine), deferred.
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... fundsReserve 0..1 CodeableConcept A code to indicate whether and for whom funds are to be reserved for future claims.
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..* BackboneElement Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 1..1 Reference(Claim) Reference to a related claim.
.... relationship 1..1 CodeableConcept A code to convey how the claims are related.
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

... prescription 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription to support the dispensing of pharmacy, device or vision products.
... originalPrescription 0..1 Reference(MedicationRequest) Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
... payee 1..1 BackboneElement The party to be reimbursed for cost of the products and services according to the terms of the policy.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of Party to be reimbursed: subscriber, provider, other.
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(SHAOrganization | SHAPractitioner | SHAPatient) Party to be reimbursed.
... referral 0..1 Reference(ServiceRequest) A reference to a referral resource.
... facility 0..1 Reference(Location) Facility where the services were provided.
... careTeam 1..* BackboneElement The members of the team who provided the products and services.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify care team entries.
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Member of the team who provided the product or service.
.... role 1..1 CodeableConcept The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 1..1 CodeableConcept The qualification of the practitioner which is applicable for this service.
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo 0..* BackboneElement Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify supporting information entries.
.... category 1..1 CodeableConcept The general class of the information supplied: information; exception; accident, employment; onset, etc.
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code 0..1 CodeableConcept System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... Slices for timing[x] 0..1 When it occurred
Slice: Unordered, Closed by type:$this
..... timingDate date
..... timingPeriod Period
..... timing[x]:timingDate 0..1 date The date when or period to which this information refers.
..... timing[x]:timingPeriod 0..1 Period The period when or period to which this information refers.
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Closed by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueBoolean 0..1 boolean Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueString 0..1 string Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueQuantity 0..1 Quantity Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueAttachment 0..1 Attachment Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueReference 0..1 Reference(Resource) A reference, either FHIR resource reference or the business identifier of an information object, for example a document in an external repository.
.... reason 0..1 CodeableConcept Provides the reason in the situation where a reason code is required in addition to the content.
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis 1..* BackboneElement Information about diagnoses relevant to the claim items.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify diagnosis entries.
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosis[x]:diagnosisCodeableConcept 1..1 CodeableConcept The diagnosis code.
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

.... type 1..1 CodeableConcept When the condition was observed or the relative ranking.
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission 0..1 CodeableConcept Indication of whether the diagnosis was present on admission to a facility.
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

... insurance Σ 1..* BackboneElement Insurance information.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
.... focal Σ 1..1 boolean A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
.... coverage Σ 1..1 Reference(Coverage) Reference to the insurance card level information contained in the Coverage resource.
.... preAuthRef 0..* string Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
.... claimResponse 0..1 Reference(ClaimResponse) The result of the adjudication of the line items for the Coverage specified in this insurance.
... accident 0..1 BackboneElement Details of an accident which resulted in injuries which required the products and services listed in the claim.
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date Date of an accident event related to the products and services contained in the claim.
.... type 1..1 CodeableConcept The type or context of the accident event for the purposes
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... Slices for location[x] 0..1 Where the event occurred
Slice: Unordered, Open by type:$this
..... locationAddress Address
..... locationReference Reference(Location)
..... location[x]:locationAddress 0..1 Address The physical location of the accident event.
... item 1..* BackboneElement A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
.... Slices for extension 3..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
..... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... itemPayerShare 1..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... itemPatientShare 1..1 Money Extension for Patient Share
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-share
..... itemPatientInvoice 1..1 Identifier Extension for Patient Invoice
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-invoice
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify item entries.
.... careTeamSequence 1..* positiveInt CareTeam members related to this service or product.
.... diagnosisSequence 0..* positiveInt Diagnosis applicable for this service or product.
.... informationSequence 0..* positiveInt Exceptions, special conditions and supporting information applicable for this service or product.
.... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
Binding: USCLSCodes (example): Allowable service and product codes.

.... Slices for serviced[x] 0..1 Date or dates of service or product delivery
Slice: Unordered, Closed by type:$this
..... servicedDate date
..... servicedPeriod Period
..... serviced[x]:servicedDate 0..1 date The date or dates when the service or product was supplied, performed or completed.
..... serviced[x]:servicedPeriod 0..1 Period The period when the service or product was supplied, performed or completed.
.... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
.... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
.... factor 0..1 decimal A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received.
.... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
.... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
.... bodySite 0..1 CodeableConcept Physical service site on the patient (limb, tooth, etc.).
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..1 CodeableConcept A region or surface of the bodySite, e.g. limb region or tooth surface(s).
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... detail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
..... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
...... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt A number to uniquely identify item entries.
..... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
Binding: USCLSCodes (example): Allowable service and product codes.

..... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
..... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
..... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
..... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
..... subDetail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt A number to uniquely identify item entries.
...... productOrService 1..1 CodeableConcept When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
Binding: USCLSCodes (example): Allowable service and product codes.

...... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
...... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
...... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
...... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
... total 1..1 Money The total value of all the items in the claim.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensibleClaimTypeCodes
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.subTypeexampleExampleClaimSubTypeCodes
http://hl7.org/fhir/ValueSet/claim-subtype
from the FHIR Standard
Claim.userequiredUse
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityexampleProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.fundsReserveexampleFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConceptexampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.bodySiteexampleOralSiteCodes
http://hl7.org/fhir/ValueSet/tooth
from the FHIR Standard
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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 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(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 1..1 id Unique string for reference purposes
... meta Σ 1..1 Meta Metadata about a resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... 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 1..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... 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): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
.... batchIdentifier 0..1 Identifier Extension for Batch Identifier
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-identifier
.... batchNumber 0..1 string Extension for Batch Number
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-number
.... batchPeriod 0..1 string Extension for Batch Period
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/batch-period
.... diagnosisRelatedGroup 0..1 CodeableConcept Extension for Diagnosis Related Group
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/diagnosis-related-group
.... encounter 0..1 Reference(Encounter) ClaimAuthorizationInstitutionalProfileEncounter
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/claim-authorization-institutional-profile-encounter
.... eligibilityResponse 0..1 Reference(SHACoverageEligibilityResponse) EligibilityResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-response
.... EligibilityOffline 0..1 string Extension for EligibilityOffline
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline
.... EligibilityOfflineDate 0..1 date Extension for Eligibility OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/eligibility-offline-date
.... authorizationOffLineDate 0..1 date Extension for authorization OffLineDate
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/authorization-offLine-date
.... priorAuthResponse 0..1 Reference(ClaimResponse | ClaimResponseAuthorizationResponseProfile) PriorAuthResponse
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/prior-auth-response
.... episode 0..1 Identifier Extension for Episode
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/episode
.... newborn 0..1 boolean Extension for Newborn
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/newborn
.... package 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 1..1 Identifier A unique identifier assigned to this claim.
... status ?!Σ 1..1 code The status of the resource instance.
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept The category of authorization
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType 1..1 CodeableConcept A finer-grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ 1..1 code A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient Σ 1..1 Reference(SHAPatient) 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.
... billablePeriod Σ 0..1 Period The period for which charges are being submitted.
... created Σ 1..1 dateTime The date this resource was created.
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 1..1 Reference(Organization) The Insurer who is target of the request.
... provider Σ 1..1 Reference(SHAOrganization | SHAPractitioner) The provider which is responsible for the claim, predetermination or preauthorization.
... priority Σ 1..1 CodeableConcept The provider-required urgency of processing the request. Typical values include: stat, normal (routine), deferred.
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... fundsReserve 0..1 CodeableConcept A code to indicate whether and for whom funds are to be reserved for future claims.
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..* BackboneElement Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 1..1 Reference(Claim) Reference to a related claim.
.... relationship 1..1 CodeableConcept A code to convey how the claims are related.
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(MedicationRequest | DeviceRequest | VisionPrescription) Prescription to support the dispensing of pharmacy, device or vision products.
... originalPrescription 0..1 Reference(MedicationRequest) Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
... payee 1..1 BackboneElement The party to be reimbursed for cost of the products and services according to the terms of the policy.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Type of Party to be reimbursed: subscriber, provider, other.
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(SHAOrganization | SHAPractitioner | SHAPatient) Party to be reimbursed.
... referral 0..1 Reference(ServiceRequest) A reference to a referral resource.
... facility 0..1 Reference(Location) Facility where the services were provided.
... careTeam 1..* BackboneElement The members of the team who provided the products and services.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify care team entries.
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Member of the team who provided the product or service.
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 1..1 CodeableConcept The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 1..1 CodeableConcept The qualification of the practitioner which is applicable for this service.
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo 0..* BackboneElement Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify supporting information entries.
.... category 1..1 CodeableConcept The general class of the information supplied: information; exception; accident, employment; onset, etc.
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code 0..1 CodeableConcept System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... Slices for timing[x] 0..1 When it occurred
Slice: Unordered, Closed by type:$this
..... timingDate date
..... timingPeriod Period
..... timing[x]:timingDate 0..1 date The date when or period to which this information refers.
..... timing[x]:timingPeriod 0..1 Period The period when or period to which this information refers.
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Closed by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueBoolean 0..1 boolean Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueString 0..1 string Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueQuantity 0..1 Quantity Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueAttachment 0..1 Attachment Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
..... value[x]:valueReference 0..1 Reference(Resource) A reference, either FHIR resource reference or the business identifier of an information object, for example a document in an external repository.
.... reason 0..1 CodeableConcept Provides the reason in the situation where a reason code is required in addition to the content.
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis 1..* BackboneElement Information about diagnoses relevant to the claim items.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify diagnosis entries.
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosis[x]:diagnosisCodeableConcept 1..1 CodeableConcept The diagnosis code.
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

.... type 1..1 CodeableConcept When the condition was observed or the relative ranking.
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission 0..1 CodeableConcept Indication of whether the diagnosis was present on admission to a facility.
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
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Insurance information.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
.... focal Σ 1..1 boolean A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(Coverage) Reference to the insurance card level information contained in the Coverage resource.
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
.... claimResponse 0..1 Reference(ClaimResponse) The result of the adjudication of the line items for the Coverage specified in this insurance.
... accident 0..1 BackboneElement Details of an accident which resulted in injuries which required the products and services listed in the claim.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date Date of an accident event related to the products and services contained in the claim.
.... type 1..1 CodeableConcept The type or context of the accident event for the purposes
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... Slices for location[x] 0..1 Where the event occurred
Slice: Unordered, Open by type:$this
..... locationAddress Address
..... locationReference Reference(Location)
..... location[x]:locationAddress 0..1 Address The physical location of the accident event.
... item 1..* BackboneElement A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 3..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
..... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... itemPayerShare 1..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... itemPatientShare 1..1 Money Extension for Patient Share
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-share
..... itemPatientInvoice 1..1 Identifier Extension for Patient Invoice
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-invoice
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt A number to uniquely identify item entries.
.... careTeamSequence 1..* positiveInt CareTeam members related to this service or product.
.... diagnosisSequence 0..* positiveInt Diagnosis applicable for this service or product.
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Exceptions, special conditions and supporting information applicable for this service or product.
.... 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 When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
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.


.... Slices for serviced[x] 0..1 Date or dates of service or product delivery
Slice: Unordered, Closed by type:$this
..... servicedDate date
..... servicedPeriod Period
..... serviced[x]:servicedDate 0..1 date The date or dates when the service or product was supplied, performed or completed.
..... serviced[x]:servicedPeriod 0..1 Period The period when the service or product was supplied, performed or completed.
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 1..1 SimpleQuantity The number of repetitions of a service or product.
.... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
.... factor 0..1 decimal A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received.
.... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
.... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
.... bodySite 0..1 CodeableConcept Physical service site on the patient (limb, tooth, etc.).
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..1 CodeableConcept A region or surface of the bodySite, e.g. limb region or tooth surface(s).
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Optional Extensions Element
Slice: Unordered, Open by value:url
...... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt A number to uniquely identify item entries.
..... 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 When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
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 1..1 SimpleQuantity The number of repetitions of a service or product.
..... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
..... factor 0..1 decimal Price scaling factor
..... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
..... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
..... subDetail 0..* BackboneElement A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
...... id 0..1 string Unique id for inter-element referencing
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... tax 0..* Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt A number to uniquely identify item entries.
...... 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 When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
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 1..1 SimpleQuantity The number of repetitions of a service or product.
...... unitPrice 1..1 Money If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
...... factor 0..1 decimal Price scaling factor
...... net 1..1 Money The quantity times the unit price for a service or product or charge times the factor plus the Tax.
...... udi 0..* Reference(Device) Unique Device Identifiers associated with this line item.
... total 1..1 Money The total value of all the items in the claim.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Claim.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
Claim.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensibleClaimTypeCodes
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.subTypeexampleExampleClaimSubTypeCodes
http://hl7.org/fhir/ValueSet/claim-subtype
from the FHIR Standard
Claim.userequiredUse
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityexampleProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.fundsReserveexampleFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConceptexampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.procedure.typeexampleExampleProcedureTypeCodes
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
http://hl7.org/fhir/ValueSet/icd-10-procedures
from the FHIR Standard
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
from the FHIR Standard
Claim.item.bodySiteexampleOralSiteCodes
http://hl7.org/fhir/ValueSet/tooth
from the FHIR Standard
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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 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(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Claim

Summary

Mandatory: 22 elements(9 nested mandatory elements)

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.supportingInfo.timing[x]
  • The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
  • The element 1 is sliced based on the value of Claim.diagnosis.diagnosis[x]
  • The element 1 is sliced based on the value of Claim.accident.location[x]
  • The element 1 is sliced based on the value of Claim.item.serviced[x]

 

Other representations of profile: CSV, Excel, Schematron