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: Claims

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

Standardise the format of electronic claims / pre-authorizations / pre-determinations.

This profile constrains the representation of a Kenyan electronic claim.

Usage:

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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... county 0..1 code Extension for Kenya counties
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/kenya-counties-extension
Binding: Counties in Kenya (required)
.... 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
.... 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
.... 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
... identifier S 1..1 Identifier Business Identifier for claim
... status 1..1 code Patient Claim's status
... subType S 0..1 CodeableConcept More granular claim type
... use S 1..1 code claim | preauthorization | predetermination
... patient S 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod S 0..1 Period Relevant time frame for the claim
... created S 1..1 dateTime Resource creation date
... insurer S 0..1 Reference(Organization) Target
... provider S 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... priority S 1..1 CodeableConcept Desired processing ugency
... related S 0..* BackboneElement Prior or corollary claims
.... claim S 0..1 Reference(Claim) Reference to the related claim
.... relationship S 0..1 CodeableConcept How the reference claim is related
... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... type S 1..1 CodeableConcept Category of recipient
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(Location) Servicing facility
... careTeam S 0..* BackboneElement Members of the care team
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... role S 0..1 CodeableConcept Function within the team
.... qualification S 0..1 CodeableConcept Practitioner credential or specialization
... supportingInfo S 0..* BackboneElement Supporting information
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
.... code S 0..1 CodeableConcept Type of information
.... Slices for timing[x] 0..1 date, Period When it occurred
Slice: Unordered, Open by type:$this
..... timing[x]:timingDate S 0..1 date When it occurred
..... timing[x]:timingPeriod S 0..1 Period When it occurred
.... Slices for value[x] 0..1 boolean, string, Quantity, Attachment, Reference(Resource) Data to be provided
Slice: Unordered, Open by type:$this
..... value[x]:valueBoolean S 0..1 boolean Data to be provided
..... value[x]:valueString S 0..1 string Data to be provided
..... value[x]:valueQuantity S 0..1 Quantity Data to be provided
..... value[x]:valueAttachment S 0..1 Attachment Data to be provided
..... value[x]:valueReference S 0..1 Reference(Resource) Data to be provided
.... reason S 0..1 CodeableConcept Explanation for the information
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 CodeableConcept, Reference(Condition) Nature of illness or problem
Slice: Unordered, Open by type:$this
..... diagnosis[x]:diagnosisCodeableConcept S 0..1 CodeableConcept Nature of illness or problem
.... type S 0..* CodeableConcept Timing or nature of the diagnosis
.... onAdmission S 0..1 CodeableConcept Present on admission
... insurance S 1..* BackboneElement Patient insurance information
.... sequence S 1..1 positiveInt Insurance instance identifier
.... focal S 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Coverage) Insurance information
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... date S 1..1 date When the incident occurred
.... type S 0..1 CodeableConcept The nature of the accident
.... Slices for location[x] 0..1 Address, Reference(Location) Where the event occurred
Slice: Unordered, Open by type:$this
..... location[x]:locationAddress S 0..1 Address Where the event occurred
... item S 0..* BackboneElement Product or service provided
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... package S 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
..... tax S 0..1 Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... payerShare S 0..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... PatientInvoice S 0..1 Identifier Extension for Patient Invoice
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-invoice
.... sequence S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 0..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
.... 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 S 0..1 date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 Period Date or dates of service or product delivery
.... quantity S 0..1 SimpleQuantity Count of products or services
.... unitPrice S 0..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 0..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
.... subSite S 0..* CodeableConcept Anatomical sub-location
.... detail S 0..* BackboneElement Product or service provided
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... itemTax S 0..1 Money Extension for ItemTax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/item-tax
..... sequence S 1..1 positiveInt Item instance identifier
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
..... quantity S 0..1 SimpleQuantity Count of products or services
..... unitPrice S 0..1 Money Fee, charge or cost per item
..... net S 0..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... sequence S 1..1 positiveInt Item instance identifier
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
...... quantity S 0..1 SimpleQuantity Count of products or services
...... unitPrice S 0..1 Money Fee, charge or cost per item
...... net S 0..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 0..1 Money Total claim cost

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... county 0..1 code Extension for Kenya counties
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/kenya-counties-extension
Binding: Counties in Kenya (required)
.... 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
.... 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
.... 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
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..1 Identifier Business Identifier for claim
... status ?!Σ 1..1 code Patient Claim's status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient SΣ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... insurer SΣ 0..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... related S 0..* BackboneElement Prior or corollary claims
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim S 0..1 Reference(Claim) Reference to the related claim
.... relationship S 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(Location) Servicing facility
... careTeam S 0..* BackboneElement Members of the care team
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... role S 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification S 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo S 0..* BackboneElement Supporting information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code S 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... Slices for timing[x] 0..1 When it occurred
Slice: Unordered, Closed by type:$this
..... timingDate date
..... timingPeriod Period
..... timing[x]:timingDate S 0..1 date When it occurred
..... timing[x]:timingPeriod S 0..1 Period When it occurred
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Closed by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueBoolean S 0..1 boolean Data to be provided
..... value[x]:valueString S 0..1 string Data to be provided
..... value[x]:valueQuantity S 0..1 Quantity Data to be provided
..... value[x]:valueAttachment S 0..1 Attachment Data to be provided
..... value[x]:valueReference S 0..1 Reference(Resource) Data to be provided
.... reason S 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Open by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept S 0..1 CodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

.... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission S 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

... insurance SΣ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence SΣ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date S 1..1 date When the incident occurred
.... type S 0..1 CodeableConcept The nature of the accident
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 S 0..1 Address Where the event occurred
... item S 0..* BackboneElement Product or service provided
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... package S 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
..... tax S 0..1 Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... payerShare S 0..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... PatientInvoice S 0..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 S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 0..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
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 S 0..1 date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 Period Date or dates of service or product delivery
.... quantity S 0..1 SimpleQuantity Count of products or services
.... unitPrice S 0..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 0..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite S 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... detail S 0..* BackboneElement Product or service provided
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... itemTax S 0..1 Money Extension for ItemTax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/item-tax
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Item instance identifier
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... quantity S 0..1 SimpleQuantity Count of products or services
..... unitPrice S 0..1 Money Fee, charge or cost per item
..... net S 0..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence S 1..1 positiveInt Item instance identifier
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... quantity S 0..1 SimpleQuantity Count of products or services
...... unitPrice S 0..1 Money Fee, charge or cost per item
...... net S 0..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 0..1 Money Total claim cost

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.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 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... 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 Extension
Slice: Unordered, Open by value:url
.... county 0..1 code Extension for Kenya counties
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/kenya-counties-extension
Binding: Counties in Kenya (required)
.... 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
.... 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
.... 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
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..1 Identifier Business Identifier for claim
... status ?!Σ 1..1 code Patient Claim's status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient SΣ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer SΣ 0..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related S 0..* BackboneElement Prior or corollary claims
.... 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 S 0..1 Reference(Claim) Reference to the related claim
.... relationship S 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(Location) Servicing facility
... careTeam S 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role S 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification S 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo S 0..* BackboneElement Supporting 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 S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code S 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... Slices for timing[x] 0..1 When it occurred
Slice: Unordered, Closed by type:$this
..... timingDate date
..... timingPeriod Period
..... timing[x]:timingDate S 0..1 date When it occurred
..... timing[x]:timingPeriod S 0..1 Period When it occurred
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Closed by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueBoolean S 0..1 boolean Data to be provided
..... value[x]:valueString S 0..1 string Data to be provided
..... value[x]:valueQuantity S 0..1 Quantity Data to be provided
..... value[x]:valueAttachment S 0..1 Attachment Data to be provided
..... value[x]:valueReference S 0..1 Reference(Resource) Data to be provided
.... reason S 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis S 0..* BackboneElement Pertinent diagnosis 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 S 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Open by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept S 0..1 CodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

.... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission S 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... 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 SΣ 1..* BackboneElement Patient 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 SΣ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the 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
.... date S 1..1 date When the incident occurred
.... type S 0..1 CodeableConcept The nature of the accident
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 S 0..1 Address Where the event occurred
... item S 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... package S 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
..... tax S 0..1 Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... payerShare S 0..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... PatientInvoice S 0..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 S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 0..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... 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 S 0..1 date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 Period Date or dates of service or product delivery
.... 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 S 0..1 SimpleQuantity Count of products or services
.... unitPrice S 0..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 0..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite S 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail S 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... itemTax S 0..1 Money Extension for ItemTax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/item-tax
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity S 0..1 SimpleQuantity Count of products or services
..... unitPrice S 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net S 0..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... 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 S 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity S 0..1 SimpleQuantity Count of products or services
...... unitPrice S 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net S 0..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
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

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... county 0..1 code Extension for Kenya counties
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/kenya-counties-extension
Binding: Counties in Kenya (required)
.... 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
.... 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
.... 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
... identifier S 1..1 Identifier Business Identifier for claim
... status 1..1 code Patient Claim's status
... subType S 0..1 CodeableConcept More granular claim type
... use S 1..1 code claim | preauthorization | predetermination
... patient S 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod S 0..1 Period Relevant time frame for the claim
... created S 1..1 dateTime Resource creation date
... insurer S 0..1 Reference(Organization) Target
... provider S 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... priority S 1..1 CodeableConcept Desired processing ugency
... related S 0..* BackboneElement Prior or corollary claims
.... claim S 0..1 Reference(Claim) Reference to the related claim
.... relationship S 0..1 CodeableConcept How the reference claim is related
... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... type S 1..1 CodeableConcept Category of recipient
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(Location) Servicing facility
... careTeam S 0..* BackboneElement Members of the care team
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... role S 0..1 CodeableConcept Function within the team
.... qualification S 0..1 CodeableConcept Practitioner credential or specialization
... supportingInfo S 0..* BackboneElement Supporting information
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
.... code S 0..1 CodeableConcept Type of information
.... Slices for timing[x] 0..1 date, Period When it occurred
Slice: Unordered, Open by type:$this
..... timing[x]:timingDate S 0..1 date When it occurred
..... timing[x]:timingPeriod S 0..1 Period When it occurred
.... Slices for value[x] 0..1 boolean, string, Quantity, Attachment, Reference(Resource) Data to be provided
Slice: Unordered, Open by type:$this
..... value[x]:valueBoolean S 0..1 boolean Data to be provided
..... value[x]:valueString S 0..1 string Data to be provided
..... value[x]:valueQuantity S 0..1 Quantity Data to be provided
..... value[x]:valueAttachment S 0..1 Attachment Data to be provided
..... value[x]:valueReference S 0..1 Reference(Resource) Data to be provided
.... reason S 0..1 CodeableConcept Explanation for the information
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 CodeableConcept, Reference(Condition) Nature of illness or problem
Slice: Unordered, Open by type:$this
..... diagnosis[x]:diagnosisCodeableConcept S 0..1 CodeableConcept Nature of illness or problem
.... type S 0..* CodeableConcept Timing or nature of the diagnosis
.... onAdmission S 0..1 CodeableConcept Present on admission
... insurance S 1..* BackboneElement Patient insurance information
.... sequence S 1..1 positiveInt Insurance instance identifier
.... focal S 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Coverage) Insurance information
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... date S 1..1 date When the incident occurred
.... type S 0..1 CodeableConcept The nature of the accident
.... Slices for location[x] 0..1 Address, Reference(Location) Where the event occurred
Slice: Unordered, Open by type:$this
..... location[x]:locationAddress S 0..1 Address Where the event occurred
... item S 0..* BackboneElement Product or service provided
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... package S 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
..... tax S 0..1 Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... payerShare S 0..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... PatientInvoice S 0..1 Identifier Extension for Patient Invoice
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/patient-invoice
.... sequence S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 0..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
.... 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 S 0..1 date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 Period Date or dates of service or product delivery
.... quantity S 0..1 SimpleQuantity Count of products or services
.... unitPrice S 0..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 0..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
.... subSite S 0..* CodeableConcept Anatomical sub-location
.... detail S 0..* BackboneElement Product or service provided
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... itemTax S 0..1 Money Extension for ItemTax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/item-tax
..... sequence S 1..1 positiveInt Item instance identifier
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
..... quantity S 0..1 SimpleQuantity Count of products or services
..... unitPrice S 0..1 Money Fee, charge or cost per item
..... net S 0..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... sequence S 1..1 positiveInt Item instance identifier
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
...... quantity S 0..1 SimpleQuantity Count of products or services
...... unitPrice S 0..1 Money Fee, charge or cost per item
...... net S 0..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 0..1 Money Total claim cost

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... county 0..1 code Extension for Kenya counties
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/kenya-counties-extension
Binding: Counties in Kenya (required)
.... 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
.... 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
.... 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
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..1 Identifier Business Identifier for claim
... status ?!Σ 1..1 code Patient Claim's status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient SΣ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... insurer SΣ 0..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... related S 0..* BackboneElement Prior or corollary claims
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim S 0..1 Reference(Claim) Reference to the related claim
.... relationship S 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(Location) Servicing facility
... careTeam S 0..* BackboneElement Members of the care team
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... role S 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification S 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo S 0..* BackboneElement Supporting information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code S 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... Slices for timing[x] 0..1 When it occurred
Slice: Unordered, Closed by type:$this
..... timingDate date
..... timingPeriod Period
..... timing[x]:timingDate S 0..1 date When it occurred
..... timing[x]:timingPeriod S 0..1 Period When it occurred
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Closed by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueBoolean S 0..1 boolean Data to be provided
..... value[x]:valueString S 0..1 string Data to be provided
..... value[x]:valueQuantity S 0..1 Quantity Data to be provided
..... value[x]:valueAttachment S 0..1 Attachment Data to be provided
..... value[x]:valueReference S 0..1 Reference(Resource) Data to be provided
.... reason S 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Open by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept S 0..1 CodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

.... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission S 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

... insurance SΣ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence SΣ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date S 1..1 date When the incident occurred
.... type S 0..1 CodeableConcept The nature of the accident
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 S 0..1 Address Where the event occurred
... item S 0..* BackboneElement Product or service provided
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... package S 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
..... tax S 0..1 Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... payerShare S 0..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... PatientInvoice S 0..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 S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 0..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
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 S 0..1 date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 Period Date or dates of service or product delivery
.... quantity S 0..1 SimpleQuantity Count of products or services
.... unitPrice S 0..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 0..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite S 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... detail S 0..* BackboneElement Product or service provided
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... itemTax S 0..1 Money Extension for ItemTax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/item-tax
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Item instance identifier
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... quantity S 0..1 SimpleQuantity Count of products or services
..... unitPrice S 0..1 Money Fee, charge or cost per item
..... net S 0..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence S 1..1 positiveInt Item instance identifier
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... quantity S 0..1 SimpleQuantity Count of products or services
...... unitPrice S 0..1 Money Fee, charge or cost per item
...... net S 0..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 0..1 Money Total claim cost

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.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 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... 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 Extension
Slice: Unordered, Open by value:url
.... county 0..1 code Extension for Kenya counties
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/kenya-counties-extension
Binding: Counties in Kenya (required)
.... 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
.... 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
.... 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
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..1 Identifier Business Identifier for claim
... status ?!Σ 1..1 code Patient Claim's status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient SΣ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer SΣ 0..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... priority SΣ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related S 0..* BackboneElement Prior or corollary claims
.... 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 S 0..1 Reference(Claim) Reference to the related claim
.... relationship S 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... prescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription S 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee S 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(Location) Servicing facility
... careTeam S 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence S 1..1 positiveInt Order of care team
.... provider S 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role S 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification S 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo S 0..* BackboneElement Supporting 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 S 1..1 positiveInt Information instance identifier
.... category S 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code S 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... Slices for timing[x] 0..1 When it occurred
Slice: Unordered, Closed by type:$this
..... timingDate date
..... timingPeriod Period
..... timing[x]:timingDate S 0..1 date When it occurred
..... timing[x]:timingPeriod S 0..1 Period When it occurred
.... Slices for value[x] 0..1 Data to be provided
Slice: Unordered, Closed by type:$this
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... value[x]:valueBoolean S 0..1 boolean Data to be provided
..... value[x]:valueString S 0..1 string Data to be provided
..... value[x]:valueQuantity S 0..1 Quantity Data to be provided
..... value[x]:valueAttachment S 0..1 Attachment Data to be provided
..... value[x]:valueReference S 0..1 Reference(Resource) Data to be provided
.... reason S 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis S 0..* BackboneElement Pertinent diagnosis 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 S 1..1 positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 Nature of illness or problem
Slice: Unordered, Open by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
..... diagnosis[x]:diagnosisCodeableConcept S 0..1 CodeableConcept Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

.... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission S 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... 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 SΣ 1..* BackboneElement Patient 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 SΣ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse S 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the 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
.... date S 1..1 date When the incident occurred
.... type S 0..1 CodeableConcept The nature of the accident
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 S 0..1 Address Where the event occurred
... item S 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... package S 0..1 boolean Extension for Package
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/package
..... tax S 0..1 Money Extension for Tax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/tax
..... payerShare S 0..1 Money Extension for PayerShare
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/payer-share
..... PatientInvoice S 0..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 S 1..1 positiveInt Item instance identifier
.... careTeamSequence S 0..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence S 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... 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 S 0..1 date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 Period Date or dates of service or product delivery
.... 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 S 0..1 SimpleQuantity Count of products or services
.... unitPrice S 0..1 Money Fee, charge or cost per item
.... factor S 0..1 decimal Price scaling factor
.... net S 0..1 Money Total item cost
.... udi S 0..* Reference(Device) Unique device identifier
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite S 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail S 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... itemTax S 0..1 Money Extension for ItemTax
URL: https://shr.tiberbuapps.com/fhir/StructureDefinition/item-tax
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence S 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity S 0..1 SimpleQuantity Count of products or services
..... unitPrice S 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net S 0..1 Money Total item cost
..... udi S 0..* Reference(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... 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 S 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity S 0..1 SimpleQuantity Count of products or services
...... unitPrice S 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net S 0..1 Money Total item cost
...... udi S 0..* Reference(Device) Unique device identifier
... total S 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
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

 

Other representations of profile: CSV, Excel, Schematron