description: null package_name: hl7.fhir.r4b.core derivation: specialization name: Claim type: Claim elements: patient: isModifier: false short: The recipient of the products and services refers: ['http://hl7.org/fhir/StructureDefinition/Patient'] type: Reference mustSupport: false isSummary: true index: 5 insurance: min: 1 isModifier: false short: Patient insurance information index: 64 type: BackboneElement mustSupport: false array: true elements: sequence: {isModifier: false, short: Insurance instance identifier, type: positiveInt, mustSupport: false, isSummary: true, index: 65} focal: {isModifier: false, short: Coverage to be used for adjudication, type: boolean, mustSupport: false, isSummary: true, index: 66} identifier: {isModifier: false, short: Pre-assigned Claim number, type: Identifier, mustSupport: false, isSummary: false, index: 67} coverage: isModifier: false short: Insurance information refers: ['http://hl7.org/fhir/StructureDefinition/Coverage'] type: Reference mustSupport: false isSummary: true index: 68 businessArrangement: {isModifier: false, short: Additional provider contract number, type: string, mustSupport: false, isSummary: false, index: 69} preAuthRef: {isModifier: false, short: Prior authorization reference number, type: string, mustSupport: false, array: true, isSummary: false, index: 70} claimResponse: isModifier: false short: Adjudication results refers: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse'] type: Reference mustSupport: false isSummary: false index: 71 required: [coverage, focal, sequence] isSummary: true facility: isModifier: false short: Servicing facility refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference mustSupport: false isSummary: false index: 23 diagnosis: isModifier: false short: Pertinent diagnosis information index: 46 type: BackboneElement mustSupport: false array: true elements: sequence: {isModifier: false, short: Diagnosis instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 47} diagnosis: isModifier: false short: Nature of illness or problem mustSupport: false choices: [diagnosisCodeableConcept, diagnosisReference] isSummary: false index: 49 diagnosisCodeableConcept: {isModifier: false, short: Nature of illness or problem, type: CodeableConcept, mustSupport: false, choiceOf: diagnosis, isSummary: false, index: 50} diagnosisReference: isModifier: false short: Nature of illness or problem index: 51 refers: ['http://hl7.org/fhir/StructureDefinition/Condition'] type: Reference mustSupport: false choiceOf: diagnosis isSummary: false type: isModifier: false short: Timing or nature of the diagnosis type: CodeableConcept mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosistype'} isSummary: false index: 52 onAdmission: isModifier: false short: Present on admission type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission'} isSummary: false index: 53 packageCode: isModifier: false short: Package billing code type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup'} isSummary: false index: 54 required: [diagnosisReference, diagnosis, diagnosisCodeableConcept, sequence] isSummary: false enterer: isModifier: false short: Author of the claim refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole'] type: Reference mustSupport: false isSummary: false index: 8 supportingInfo: isModifier: false short: Supporting information index: 30 type: BackboneElement mustSupport: false array: true elements: category: isModifier: false short: Classification of the supplied information type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-informationcategory'} isSummary: false index: 32 valueReference: isModifier: false short: Data to be provided refers: ['http://hl7.org/fhir/StructureDefinition/Resource'] type: Reference mustSupport: false choiceOf: value isSummary: false index: 44 valueQuantity: {isModifier: false, short: Data to be provided, type: Quantity, mustSupport: false, choiceOf: value, isSummary: false, index: 42} timingPeriod: {isModifier: false, short: When it occurred, type: Period, mustSupport: false, choiceOf: timing, isSummary: false, index: 37} value: isModifier: false short: Data to be provided mustSupport: false choices: [valueBoolean, valueString, valueQuantity, valueAttachment, valueReference] isSummary: false index: 39 valueString: {isModifier: false, short: Data to be provided, type: string, mustSupport: false, choiceOf: value, isSummary: false, index: 41} valueBoolean: {isModifier: false, short: Data to be provided, type: boolean, mustSupport: false, choiceOf: value, isSummary: false, index: 40} reason: isModifier: false short: Explanation for the information type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/missing-tooth-reason'} isSummary: false index: 45 timing: isModifier: false short: When it occurred mustSupport: false choices: [timingDate, timingPeriod] isSummary: false index: 35 sequence: {isModifier: false, short: Information instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 31} code: isModifier: false short: Type of information type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-exception'} isSummary: false index: 33 timingDate: {isModifier: false, short: When it occurred, type: date, mustSupport: false, choiceOf: timing, isSummary: false, index: 36} valueAttachment: {isModifier: false, short: Data to be provided, type: Attachment, mustSupport: false, choiceOf: value, isSummary: false, index: 43} required: [sequence, category] isSummary: false use: isModifier: false short: claim | preauthorization | predetermination type: code mustSupport: false binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/claim-use|4.1.0'} isSummary: true index: 4 item: isModifier: false short: Product or service provided index: 79 type: BackboneElement mustSupport: false array: true elements: category: isModifier: false short: Benefit classification type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'} isSummary: false index: 86 diagnosisSequence: {isModifier: false, short: Applicable diagnoses, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 82} procedureSequence: {isModifier: false, short: Applicable procedures, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 83} locationAddress: {isModifier: false, short: Place of service or where product was supplied, type: Address, mustSupport: false, choiceOf: location, isSummary: false, index: 97} modifier: isModifier: false short: Product or service billing modifiers type: CodeableConcept mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'} isSummary: false index: 88 revenue: isModifier: false short: Revenue or cost center code type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'} isSummary: false index: 85 encounter: isModifier: false short: Encounters related to this billed item refers: ['http://hl7.org/fhir/StructureDefinition/Encounter'] type: Reference mustSupport: false array: true isSummary: false index: 106 locationCodeableConcept: {isModifier: false, short: Place of service or where product was supplied, type: CodeableConcept, mustSupport: false, choiceOf: location, isSummary: false, index: 96} net: {isModifier: false, short: Total item cost, type: Money, mustSupport: false, isSummary: false, index: 102} serviced: isModifier: false short: Date or dates of service or product delivery mustSupport: false choices: [servicedDate, servicedPeriod] isSummary: false index: 91 subSite: isModifier: false short: Anatomical sub-location type: CodeableConcept mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/surface'} isSummary: false index: 105 careTeamSequence: {isModifier: false, short: Applicable careTeam members, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 81} productOrService: isModifier: false short: Billing, service, product, or drug code type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'} isSummary: false index: 87 locationReference: isModifier: false short: Place of service or where product was supplied refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference mustSupport: false choiceOf: location isSummary: false index: 98 udi: isModifier: false short: Unique device identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference mustSupport: false array: true isSummary: false index: 103 informationSequence: {isModifier: false, short: Applicable exception and supporting information, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 84} programCode: isModifier: false short: Program the product or service is provided under type: CodeableConcept mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'} isSummary: false index: 89 factor: {isModifier: false, short: Price scaling factor, type: decimal, mustSupport: false, isSummary: false, index: 101} servicedDate: {isModifier: false, short: Date or dates of service or product delivery, type: date, mustSupport: false, choiceOf: serviced, isSummary: false, index: 92} sequence: {isModifier: false, short: Item instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 80} bodySite: isModifier: false short: Anatomical location type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/tooth'} isSummary: false index: 104 quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 99} location: isModifier: false short: Place of service or where product was supplied mustSupport: false choices: [locationCodeableConcept, locationAddress, locationReference] isSummary: false index: 95 unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 100} servicedPeriod: {isModifier: false, short: Date or dates of service or product delivery, type: Period, mustSupport: false, choiceOf: serviced, isSummary: false, index: 93} detail: isModifier: false short: Product or service provided index: 107 type: BackboneElement mustSupport: false array: true elements: category: isModifier: false short: Benefit classification type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'} isSummary: false index: 110 modifier: isModifier: false short: Service/Product billing modifiers type: CodeableConcept mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'} isSummary: false index: 112 revenue: isModifier: false short: Revenue or cost center code type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'} isSummary: false index: 109 net: {isModifier: false, short: Total item cost, type: Money, mustSupport: false, isSummary: false, index: 117} productOrService: isModifier: false short: Billing, service, product, or drug code type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'} isSummary: false index: 111 udi: isModifier: false short: Unique device identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference mustSupport: false array: true isSummary: false index: 118 programCode: isModifier: false short: Program the product or service is provided under type: CodeableConcept mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'} isSummary: false index: 113 factor: {isModifier: false, short: Price scaling factor, type: decimal, mustSupport: false, isSummary: false, index: 116} sequence: {isModifier: false, short: Item instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 108} subDetail: isModifier: false short: Product or service provided index: 119 type: BackboneElement mustSupport: false array: true elements: category: isModifier: false short: Benefit classification type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'} isSummary: false index: 122 modifier: isModifier: false short: Service/Product billing modifiers type: CodeableConcept mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'} isSummary: false index: 124 revenue: isModifier: false short: Revenue or cost center code type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'} isSummary: false index: 121 net: {isModifier: false, short: Total item cost, type: Money, mustSupport: false, isSummary: false, index: 129} productOrService: isModifier: false short: Billing, service, product, or drug code type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'} isSummary: false index: 123 udi: isModifier: false short: Unique device identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference mustSupport: false array: true isSummary: false index: 130 programCode: isModifier: false short: Program the product or service is provided under type: CodeableConcept mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'} isSummary: false index: 125 factor: {isModifier: false, short: Price scaling factor, type: decimal, mustSupport: false, isSummary: false, index: 128} sequence: {isModifier: false, short: Item instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 120} quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 126} unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 127} required: [sequence, productOrService] isSummary: false quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 114} unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 115} required: [sequence, productOrService] isSummary: false required: [sequence, productOrService] isSummary: false type: isModifier: false short: Category or discipline type: CodeableConcept mustSupport: false binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/claim-type'} isSummary: true index: 2 created: {isModifier: false, short: Resource creation date, type: dateTime, mustSupport: false, isSummary: true, index: 7} procedure: isModifier: false short: Clinical procedures performed index: 55 type: BackboneElement mustSupport: false array: true elements: sequence: {isModifier: false, short: Procedure instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 56} type: isModifier: false short: Category of Procedure type: CodeableConcept mustSupport: false array: true binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-procedure-type'} isSummary: false index: 57 date: {isModifier: false, short: When the procedure was performed, type: dateTime, mustSupport: false, isSummary: false, index: 58} procedure: isModifier: false short: Specific clinical procedure mustSupport: false choices: [procedureCodeableConcept, procedureReference] isSummary: false index: 60 procedureCodeableConcept: {isModifier: false, short: Specific clinical procedure, type: CodeableConcept, mustSupport: false, choiceOf: procedure, isSummary: false, index: 61} procedureReference: isModifier: false short: Specific clinical procedure index: 62 refers: ['http://hl7.org/fhir/StructureDefinition/Procedure'] type: Reference mustSupport: false choiceOf: procedure isSummary: false udi: isModifier: false short: Unique device identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference mustSupport: false array: true isSummary: false index: 63 required: [procedureReference, sequence, procedure, procedureCodeableConcept] isSummary: false related: isModifier: false short: Prior or corollary claims type: BackboneElement mustSupport: false array: true isSummary: false index: 13 elements: claim: isModifier: false short: Reference to the related claim refers: ['http://hl7.org/fhir/StructureDefinition/Claim'] type: Reference mustSupport: false isSummary: false index: 14 relationship: isModifier: false short: How the reference claim is related type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/related-claim-relationship'} isSummary: false index: 15 reference: {isModifier: false, short: File or case reference, type: Identifier, mustSupport: false, isSummary: false, index: 16} referral: isModifier: false short: Treatment referral refers: ['http://hl7.org/fhir/StructureDefinition/ServiceRequest'] type: Reference mustSupport: false isSummary: false index: 22 total: {isModifier: false, short: Total claim cost, type: Money, mustSupport: false, isSummary: false, index: 131} insurer: isModifier: false short: Target refers: ['http://hl7.org/fhir/StructureDefinition/Organization'] type: Reference mustSupport: false isSummary: true index: 9 fundsReserve: isModifier: false short: For whom to reserve funds type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/fundsreserve'} isSummary: false index: 12 priority: isModifier: false short: Desired processing ugency type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'} isSummary: true index: 11 accident: isModifier: false short: Details of the event type: BackboneElement mustSupport: false isSummary: false index: 72 elements: date: {isModifier: false, short: When the incident occurred, type: date, mustSupport: false, isSummary: false, index: 73} type: isModifier: false short: The nature of the accident type: CodeableConcept mustSupport: false binding: {strength: extensible, valueSet: 'http://terminology.hl7.org/ValueSet/v3-ActIncidentCode'} isSummary: false index: 74 location: isModifier: false short: Where the event occurred mustSupport: false choices: [locationAddress, locationReference] isSummary: false index: 76 locationAddress: {isModifier: false, short: Where the event occurred, type: Address, mustSupport: false, choiceOf: location, isSummary: false, index: 77} locationReference: isModifier: false short: Where the event occurred refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference mustSupport: false choiceOf: location isSummary: false index: 78 required: [date] status: isModifier: true short: active | cancelled | draft | entered-in-error index: 1 type: code mustSupport: false binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status|4.1.0'} isModifierReason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid isSummary: true payee: isModifier: false short: Recipient of benefits payable type: BackboneElement mustSupport: false isSummary: false index: 19 elements: type: isModifier: false short: Category of recipient type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/payeetype'} isSummary: false index: 20 party: isModifier: false short: Recipient reference refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Patient', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson'] type: Reference mustSupport: false isSummary: false index: 21 required: [type] prescription: isModifier: false short: Prescription authorizing services and products refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription'] type: Reference mustSupport: false isSummary: false index: 17 billablePeriod: {isModifier: false, short: Relevant time frame for the claim, type: Period, mustSupport: false, isSummary: true, index: 6} identifier: {isModifier: false, short: Business Identifier for claim, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 0} subType: isModifier: false short: More granular claim type type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-subtype'} isSummary: false index: 3 provider: isModifier: false short: Party responsible for the claim refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole'] type: Reference mustSupport: false isSummary: true index: 10 originalPrescription: isModifier: false short: Original prescription if superseded by fulfiller refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription'] type: Reference mustSupport: false isSummary: false index: 18 careTeam: isModifier: false short: Members of the care team index: 24 type: BackboneElement mustSupport: false array: true elements: sequence: {isModifier: false, short: Order of care team, type: positiveInt, mustSupport: false, isSummary: false, index: 25} provider: isModifier: false short: Practitioner or organization refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole'] type: Reference mustSupport: false isSummary: false index: 26 responsible: {isModifier: false, short: Indicator of the lead practitioner, type: boolean, mustSupport: false, isSummary: false, index: 27} role: isModifier: false short: Function within the team type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-careteamrole'} isSummary: false index: 28 qualification: isModifier: false short: Practitioner credential or specialization type: CodeableConcept mustSupport: false binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/provider-qualification'} isSummary: false index: 29 required: [provider, sequence] isSummary: false package_version: 4.1.0 class: resource kind: resource url: http://hl7.org/fhir/StructureDefinition/Claim base: http://hl7.org/fhir/StructureDefinition/DomainResource version: 4.1.0 required: [created, priority, provider, status, insurance, type, patient, use]