description: This profile sets minimum expectations for the providers and payors, insurers, to exchange the financial information, and supporting clinical information.
package_name: ndhm.in
derivation: constraint
name: Claim
type: Claim
elements:
  patient:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient']
    index: 1
  insurance:
    mustSupport: true
    index: 24
    elements:
      preAuthRef: {index: 25}
      claimResponse:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse']
        index: 26
    required: [preAuthRef]
  diagnosis:
    index: 14
    elements:
      diagnosis:
        choices: [diagnosisCodeableConcept, diagnosisReference]
        index: 16
      diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 17}
      diagnosisReference:
        type: Reference
        choiceOf: diagnosis
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition']
        index: 18
      type: {index: 19}
    required: [type]
  enterer:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
    index: 2
  supportingInfo:
    mustSupport: true
    index: 11
    elements:
      category:
        binding: {strength: preferred, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-supportinginfo-category'}
        index: 12
      code:
        binding: {strength: preferred, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-supportinginfo-code'}
        index: 13
  item:
    mustSupport: true
    index: 27
    elements:
      category:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-benefitcategory'}
        index: 28
      productOrService:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
        index: 29
      programCode:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-program-code'}
        index: 30
      encounter:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Encounter']
        index: 31
      detail:
        elements:
          category:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-benefitcategory'}
            index: 32
          productOrService:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
            index: 33
          programCode:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-program-code'}
            index: 34
          subDetail:
            elements:
              category:
                binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-benefitcategory'}
                index: 35
              productOrService:
                binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
                index: 36
              programCode:
                binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-program-code'}
                index: 37
  procedure:
    elements:
      procedure:
        choices: [procedureCodeableConcept, procedureReference]
        index: 21
      procedureCodeableConcept: {type: CodeableConcept, choiceOf: procedure, index: 22}
      procedureReference:
        type: Reference
        choiceOf: procedure
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Procedure']
        index: 23
  related:
    elements:
      claim:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim']
        index: 5
  referral:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/ServiceRequest']
    index: 9
  insurer:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
    index: 3
  payee:
    elements:
      party:
        type: Reference
        refers: ['http://hl7.org/fhir/StructureDefinition/RelatedPerson', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
        index: 8
  prescription:
    type: Reference
    refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/MedicationRequest']
    index: 6
  identifier: {mustSupport: true, index: 0}
  provider:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
    index: 4
  originalPrescription:
    type: Reference
    refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/MedicationRequest']
    index: 7
  careTeam:
    elements:
      provider:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
        index: 10
package_version: 3.0.1
class: profile
kind: resource
url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 3.0.1
required: [insurer, diagnosis, identifier, item]