{
"description": "Base StructureDefinition for Claim Resource",
"_filename": "StructureDefinition-Claim.json",
"package_name": "hl7.fhir.r2b.examples",
"date": null,
"derivation": "specialization",
"meta": {
"lastUpdated": "2016-03-31T08:01:25.570+11:00"
},
"publisher": "Health Level Seven International (Financial Management)",
"fhirVersion": "1.6.0",
"name": "Claim",
"mapping": [ {
"uri": "http://hl7.org/fhir/w5",
"name": "W5 Mapping",
"identity": "w5"
}, {
"uri": "http://hl7.org/v3",
"name": "RIM",
"identity": "rim"
} ],
"baseType": "Claim",
"abstract": false,
"type": null,
"experimental": "false",
"resourceType": "StructureDefinition",
"title": null,
"package_version": "1.4.0",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0
} ],
"snapshot": {
"element": [ {
"path": "Claim",
"min": 0,
"definition": "A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.",
"isModifier": false,
"short": "Claim, Pre-determination or Pre-authorization",
"mapping": [ {
"map": "financial.billing",
"identity": "w5"
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim"
},
"isSummary": true
}, {
"path": "Claim.id",
"min": 0,
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"isModifier": false,
"short": "Logical id of this artifact",
"comments": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.",
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Resource.id"
},
"isSummary": true
}, {
"path": "Claim.meta",
"min": 0,
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.",
"isModifier": false,
"short": "Metadata about the resource",
"type": [ {
"code": "Meta"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Resource.meta"
},
"isSummary": true
}, {
"path": "Claim.implicitRules",
"min": 0,
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.",
"isModifier": true,
"short": "A set of rules under which this content was created",
"comments": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.",
"type": [ {
"code": "uri"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Resource.implicitRules"
},
"isSummary": true
}, {
"path": "Claim.language",
"min": 0,
"definition": "The base language in which the resource is written.",
"isModifier": false,
"short": "Language of the resource content",
"comments": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"type": [ {
"code": "code"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "A human language.",
"valueSetUri": "http://tools.ietf.org/html/bcp47"
},
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Resource.language"
},
"isSummary": false
}, {
"path": "Claim.text",
"min": 0,
"definition": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"isModifier": false,
"short": "Text summary of the resource, for human interpretation",
"comments": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.",
"mapping": [ {
"map": "Act.text?",
"identity": "rim"
} ],
"type": [ {
"code": "Narrative"
} ],
"mustSupport": false,
"alias": [ "narrative", "html", "xhtml", "display" ],
"max": "1",
"condition": [ "dom-1" ],
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.text"
},
"isSummary": false
}, {
"path": "Claim.contained",
"min": 0,
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"isModifier": false,
"short": "Contained, inline Resources",
"comments": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Resource"
} ],
"mustSupport": false,
"alias": [ "inline resources", "anonymous resources", "contained resources" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.contained"
},
"isSummary": false
}, {
"path": "Claim.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.extension"
},
"isSummary": false
}, {
"path": "Claim.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.modifierExtension"
},
"isSummary": false
}, {
"path": "Claim.type",
"min": 1,
"definition": "The category of claim.",
"isModifier": false,
"short": "institutional | oral | pharmacy | professional | vision",
"comments": "Affects which fields and value sets are used.",
"type": [ {
"code": "code"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "The type or discipline-style of the claim",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-type-link"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.type"
},
"isSummary": true
}, {
"path": "Claim.subType",
"min": 0,
"definition": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.",
"isModifier": false,
"short": "Finer grained claim type information",
"comments": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "A more granulat claim typecode",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-subtype"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.subType"
},
"isSummary": true
}, {
"path": "Claim.identifier",
"min": 0,
"definition": "The business identifier for the instance: claim number, pre-determination or pre-authorization number.",
"isModifier": false,
"short": "Claim number",
"type": [ {
"code": "Identifier"
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.identifier"
},
"isSummary": true
}, {
"path": "Claim.ruleset",
"min": 0,
"definition": "The version of the specification on which this instance relies.",
"isModifier": false,
"short": "Current specification followed",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
},
"alias": [ "BusinessVersion" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.ruleset"
},
"isSummary": true
}, {
"path": "Claim.originalRuleset",
"min": 0,
"definition": "The version of the specification from which the original instance was created.",
"isModifier": false,
"short": "Original specification followed",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
},
"alias": [ "OriginalBusinessVersion" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.originalRuleset"
},
"isSummary": true
}, {
"path": "Claim.created",
"min": 0,
"definition": "The date when the enclosed suite of services were performed or completed.",
"isModifier": false,
"short": "Creation date",
"type": [ {
"code": "dateTime"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.created"
},
"isSummary": true
}, {
"path": "Claim.billablePeriod",
"min": 0,
"definition": "The billable period for which charges are being submitted.",
"isModifier": false,
"short": "Period for charge submission",
"type": [ {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.billablePeriod"
},
"isSummary": true
}, {
"path": "Claim.target[x]",
"min": 0,
"definition": "Insurer Identifier, typical BIN number (6 digit).",
"isModifier": false,
"short": "Insurer",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.target[x]"
},
"isSummary": true
}, {
"path": "Claim.provider[x]",
"min": 0,
"definition": "The provider which is responsible for the bill, claim pre-determination, pre-authorization.",
"isModifier": false,
"short": "Responsible provider",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.provider[x]"
},
"isSummary": true
}, {
"path": "Claim.organization[x]",
"min": 0,
"definition": "The organization which is responsible for the bill, claim pre-determination, pre-authorization.",
"isModifier": false,
"short": "Responsible organization",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.organization[x]"
},
"isSummary": true
}, {
"path": "Claim.use",
"min": 0,
"definition": "Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).",
"isModifier": false,
"short": "complete | proposed | exploratory | other",
"type": [ {
"code": "code"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Complete, proposed, exploratory, other",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-use-link"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.use"
},
"isSummary": true
}, {
"path": "Claim.priority",
"min": 0,
"definition": "Immediate (STAT), best effort (NORMAL), deferred (DEFER).",
"isModifier": false,
"short": "Desired processing priority",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The timeliness with which processing is required: STAT, normal, Deferred",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/process-priority"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.priority"
},
"isSummary": true
}, {
"path": "Claim.fundsReserve",
"min": 0,
"definition": "In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.",
"isModifier": false,
"short": "Funds requested to be reserved",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fundsreserve"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.fundsReserve"
},
"isSummary": true
}, {
"path": "Claim.enterer[x]",
"min": 0,
"definition": "Person who created the invoice/claim/pre-determination or pre-authorization.",
"isModifier": false,
"short": "Author",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.enterer[x]"
},
"isSummary": true
}, {
"path": "Claim.facility[x]",
"min": 0,
"definition": "Facility where the services were provided.",
"isModifier": false,
"short": "Servicing Facility",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.facility[x]"
},
"isSummary": true
}, {
"path": "Claim.related",
"min": 0,
"definition": "Other claims which are related to this claim such as prior claim versions or for related services.",
"isModifier": false,
"short": "Related Claims which may be revelant to processing this claimn",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "RelatedClaims"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.related"
},
"isSummary": true
}, {
"path": "Claim.related.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.related.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.related.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.related.claim[x]",
"min": 0,
"definition": "Other claims which are related to this claim such as prior claim versions or for related services.",
"isModifier": false,
"short": "Reference to the related claim",
"comments": "Do we need a relationship code?",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Claim" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.related.claim[x]"
},
"isSummary": true
}, {
"path": "Claim.related.relationship",
"min": 0,
"definition": "For example prior or umbrella.",
"isModifier": false,
"short": "How the reference claim is related",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Relationship of this claim to a related Claim",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/related-claim-relationship"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.related.relationship"
},
"isSummary": true
}, {
"path": "Claim.related.reference",
"min": 0,
"definition": "An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # .",
"isModifier": false,
"short": "Related file or case reference",
"type": [ {
"code": "Identifier"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.related.reference"
},
"isSummary": true
}, {
"path": "Claim.prescription[x]",
"requirements": "For type=Pharmacy and Vision only.",
"min": 0,
"definition": "Prescription to support the dispensing of Pharmacy or Vision products.",
"isModifier": false,
"short": "Prescription",
"comments": "Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence.",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/MedicationOrder" ]
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/VisionPrescription" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.prescription[x]"
},
"isSummary": true
}, {
"path": "Claim.originalPrescription[x]",
"min": 0,
"definition": "Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products.",
"isModifier": false,
"short": "Original Prescription",
"comments": "as above.",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/MedicationOrder" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.originalPrescription[x]"
},
"isSummary": true
}, {
"path": "Claim.payee",
"min": 0,
"definition": "The party to be reimbursed for the services.",
"isModifier": false,
"short": "Party to be paid any benefits payable",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Payee"
} ],
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.payee"
},
"isSummary": true
}, {
"path": "Claim.payee.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.payee.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.payee.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.payee.type",
"min": 1,
"definition": "Type of Party to be reimbursed: Subscriber, provider, other.",
"isModifier": false,
"short": "Type of party: Subscriber, Provider, other",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "A code for the party to be reimbursed.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/payeetype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.payee.type"
},
"isSummary": true
}, {
"path": "Claim.payee.party[x]",
"min": 0,
"definition": "Party to be reimbursed: Subscriber, provider, other.",
"isModifier": false,
"short": "Party to receive the payable",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.payee.party[x]"
},
"isSummary": true
}, {
"path": "Claim.referral[x]",
"min": 0,
"definition": "The referral resource which lists the date, practitioner, reason and other supporting information.",
"isModifier": false,
"short": "Treatment Referral",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/ReferralRequest" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.referral[x]"
},
"isSummary": true
}, {
"path": "Claim.occurrenceCode",
"min": 0,
"definition": "**Insert definition of Occurrence codes.",
"isModifier": false,
"short": "Occurrence Codes",
"comments": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Occurrence codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/occurrence-codes"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.occurrenceCode"
},
"isSummary": true
}, {
"path": "Claim.occurenceSpanCode",
"min": 0,
"definition": "**Insert definition of Occurrence Span codes.",
"isModifier": false,
"short": "Occurrence Span Codes",
"comments": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Occurrence Span codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/occurrence-span-codes"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.occurenceSpanCode"
},
"isSummary": true
}, {
"path": "Claim.valueCode",
"min": 0,
"definition": "**Insert definition of Value codes.",
"isModifier": false,
"short": "Value Codes",
"comments": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Value code",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/value-codes"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.valueCode"
},
"isSummary": true
}, {
"path": "Claim.diagnosis",
"min": 0,
"definition": "Ordered list of patient diagnosis for which care is sought.",
"isModifier": false,
"short": "Diagnosis",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Diagnosis"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.diagnosis"
},
"isSummary": true
}, {
"path": "Claim.diagnosis.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.diagnosis.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.diagnosis.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.diagnosis.sequence",
"requirements": "Required to maintain order of the diagnoses.",
"min": 1,
"definition": "Sequence of diagnosis which serves to order and provide a link.",
"isModifier": false,
"short": "Number to covey order of diagnosis",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.diagnosis.sequence"
},
"isSummary": true
}, {
"path": "Claim.diagnosis.diagnosis",
"requirements": "Required to adjudicate services rendered to condition presented.",
"min": 1,
"definition": "The diagnosis.",
"isModifier": false,
"short": "Patient's list of diagnosis",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "ICD10 Diagnostic codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/icd-10"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.diagnosis.diagnosis"
},
"isSummary": true
}, {
"path": "Claim.procedure",
"min": 0,
"definition": "Ordered list of patient procedures performed to support the adjudication.",
"isModifier": false,
"short": "Procedures performed",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Procedure"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.procedure"
},
"isSummary": true
}, {
"path": "Claim.procedure.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.procedure.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.procedure.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.procedure.sequence",
"requirements": "Required to maintain order of the procudures.",
"min": 1,
"definition": "Sequence of procedures which serves to order and provide a link.",
"isModifier": false,
"short": "Procedure sequence for reference",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.procedure.sequence"
},
"isSummary": true
}, {
"path": "Claim.procedure.date",
"requirements": "Required to adjudicate services rendered.",
"min": 0,
"definition": "Date and optionally time the procedure was performed .",
"isModifier": false,
"short": "When the procedure was performed",
"comments": "SB DateTime??",
"type": [ {
"code": "dateTime"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.procedure.date"
},
"isSummary": true
}, {
"path": "Claim.procedure.procedure[x]",
"requirements": "Required to adjudicate services rendered.",
"min": 1,
"definition": "The procedure code.",
"isModifier": false,
"short": "Patient's list of procedures performed",
"type": [ {
"code": "Coding"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Procedure" ]
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "ICD10 Procedure codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/icd-10-procedures"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.procedure.procedure[x]"
},
"isSummary": true
}, {
"path": "Claim.specialCondition",
"min": 0,
"definition": "List of special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication.",
"isModifier": false,
"short": "List of special Conditions",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Patient conditions and symptoms",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-conditions"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.specialCondition"
},
"isSummary": true
}, {
"path": "Claim.patient[x]",
"min": 1,
"definition": "Patient Resource.",
"isModifier": false,
"short": "The subject of the Products and Services",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.patient[x]"
},
"isSummary": true
}, {
"path": "Claim.coverage",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"definition": "Financial instrument by which payment information for health care.",
"isModifier": false,
"short": "Insurance or medical plan",
"mapping": [ {
"map": "Coverage",
"identity": "rim"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Coverage"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.coverage"
},
"isSummary": true
}, {
"path": "Claim.coverage.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.coverage.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.coverage.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.coverage.sequence",
"requirements": "To maintain order of the coverages.",
"min": 1,
"definition": "A service line item.",
"isModifier": false,
"short": "Service instance identifier",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.sequence"
},
"isSummary": true
}, {
"path": "Claim.coverage.focal",
"requirements": "To identify which coverage is being adjudicated.",
"min": 1,
"definition": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
"isModifier": false,
"short": "Is the focal Coverage",
"type": [ {
"code": "boolean"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.focal"
},
"isSummary": true
}, {
"path": "Claim.coverage.coverage[x]",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min": 1,
"definition": "Reference to the program or plan identification, underwriter or payor.",
"isModifier": false,
"short": "Insurance information",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.coverage[x]"
},
"isSummary": true
}, {
"path": "Claim.coverage.businessArrangement",
"min": 0,
"definition": "The contract number of a business agreement which describes the terms and conditions.",
"isModifier": false,
"short": "Business agreement",
"type": [ {
"code": "string"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.businessArrangement"
},
"isSummary": true
}, {
"path": "Claim.coverage.preAuthRef",
"requirements": "To provide any pre=determination or prior authorization reference.",
"min": 0,
"definition": "A list of references from the Insurer to which these services pertain.",
"isModifier": false,
"short": "Pre-Authorization/Determination Reference",
"type": [ {
"code": "string"
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.coverage.preAuthRef"
},
"isSummary": true
}, {
"path": "Claim.coverage.claimResponse",
"requirements": "Used by downstream payers to determine what balance remains and the net payable.",
"min": 0,
"definition": "The Coverages adjudication details.",
"isModifier": false,
"short": "Adjudication results",
"type": [ {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/ClaimResponse" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.claimResponse"
},
"isSummary": true
}, {
"path": "Claim.coverage.originalRuleset",
"requirements": "Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated.",
"min": 0,
"definition": "The style (standard) and version of the original material which was converted into this resource.",
"isModifier": false,
"short": "Original version",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.originalRuleset"
},
"isSummary": true
}, {
"path": "Claim.accidentDate",
"requirements": "Coverage may be dependant on accidents.",
"min": 0,
"definition": "Date of an accident which these services are addressing.",
"isModifier": false,
"short": "When the accident occurred",
"type": [ {
"code": "date"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.accidentDate"
},
"isSummary": true
}, {
"path": "Claim.accidentType",
"requirements": "Coverage may be dependant on the type of accident.",
"min": 0,
"definition": "Type of accident: work, auto, etc.",
"isModifier": false,
"short": "The nature of the accident",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Type of accident: work place, auto, etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/v3-ActIncidentCode"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.accidentType"
},
"isSummary": true
}, {
"path": "Claim.accidentLocation[x]",
"min": 0,
"definition": "Accident Place.",
"isModifier": false,
"short": "Accident Place",
"type": [ {
"code": "Address"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.accidentLocation[x]"
},
"isSummary": true
}, {
"path": "Claim.interventionException",
"requirements": "Coverage may be modified based on exception information provided.",
"min": 0,
"definition": "A list of intervention and exception codes which may influence the adjudication of the claim.",
"isModifier": false,
"short": "Intervention and exception code (Pharma)",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Intervention and exception codes (Pharm)",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/intervention"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.interventionException"
},
"isSummary": true
}, {
"path": "Claim.onset",
"min": 0,
"definition": "Period, start and last dates of aspects of the Condition or related services.",
"isModifier": false,
"short": "Condition related Onset related dates and codes",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Onset"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.onset"
},
"isSummary": true
}, {
"path": "Claim.onset.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.onset.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.onset.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.onset.time[x]",
"min": 0,
"definition": "The start or start and end dates for the treatable condition.",
"isModifier": false,
"short": "Illness, injury or treatable condition date",
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.onset.time[x]"
},
"isSummary": true
}, {
"path": "Claim.onset.type",
"min": 0,
"definition": "Onset typifications eg. Start of pregnancy, start of illnes, etc.",
"isModifier": false,
"short": "Onset of what",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Condition related start, end and period codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-onsettype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.onset.type"
},
"isSummary": true
}, {
"path": "Claim.employmentImpacted",
"min": 0,
"definition": "The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).",
"isModifier": false,
"short": "Period unable to work",
"type": [ {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.employmentImpacted"
},
"isSummary": true
}, {
"path": "Claim.hospitalization",
"min": 0,
"definition": "The start and optional end dates of when the patient was confined to a treatment center.",
"isModifier": false,
"short": "Period in hospital",
"type": [ {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.hospitalization"
},
"isSummary": true
}, {
"path": "Claim.item",
"min": 0,
"definition": "First tier of goods and services.",
"isModifier": false,
"short": "Goods and Services",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Items"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item"
},
"isSummary": true
}, {
"path": "Claim.item.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.item.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.item.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.item.sequence",
"min": 1,
"definition": "A service line number.",
"isModifier": false,
"short": "Service instance",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.sequence"
},
"isSummary": true
}, {
"path": "Claim.item.type",
"min": 1,
"definition": "The type of product or service.",
"isModifier": false,
"short": "Group or type of product or service",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Group, Service, Product.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-itemtype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.type"
},
"isSummary": true
}, {
"path": "Claim.item.provider[x]",
"min": 0,
"definition": "The practitioner who is responsible for the services rendered to the patient.",
"isModifier": false,
"short": "Responsible practitioner",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.provider[x]"
},
"isSummary": true
}, {
"path": "Claim.item.supervisor[x]",
"min": 0,
"definition": "The practitioner who is supervising the work of the servicing provider(s).",
"isModifier": false,
"short": "Supervising Practitioner",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.supervisor[x]"
},
"isSummary": true
}, {
"path": "Claim.item.providerQualification",
"min": 0,
"definition": "The qualification which is applicable for this service.",
"isModifier": false,
"short": "Type, classification or Specialization",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Provider professional qualifications",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/provider-qualification"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.providerQualification"
},
"isSummary": true
}, {
"path": "Claim.item.diagnosisLinkId",
"min": 0,
"definition": "Diagnosis applicable for this service or product line.",
"isModifier": false,
"short": "Applicable diagnoses",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.diagnosisLinkId"
},
"isSummary": true
}, {
"path": "Claim.item.service",
"min": 1,
"definition": "If a grouping item then 'GROUP' otherwise it is a node therefore a code to indicate the Professional Service or Product supplied.",
"isModifier": false,
"short": "Item Code",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.service"
},
"isSummary": true
}, {
"path": "Claim.item.serviceModifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Unusual circumstances which may influence adjudication.",
"isModifier": false,
"short": "Service/Product modifiers",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Factors which may influce adjudication of services",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-modifiers"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.serviceModifier"
},
"isSummary": true
}, {
"path": "Claim.item.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"isModifier": false,
"short": "Service/Product billing modifiers",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.modifier"
},
"isSummary": true
}, {
"path": "Claim.item.programCode",
"min": 0,
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Program specific reason codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.programCode"
},
"isSummary": true
}, {
"path": "Claim.item.serviced[x]",
"min": 0,
"definition": "The date or dates when the enclosed suite of services were performed or completed.",
"isModifier": false,
"short": "Date or dates of Service",
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.serviced[x]"
},
"isSummary": true
}, {
"path": "Claim.item.place",
"min": 0,
"definition": "Where the service was provided.",
"isModifier": false,
"short": "Place of service",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-place"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.place"
},
"isSummary": true
}, {
"path": "Claim.item.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.quantity"
},
"isSummary": true
}, {
"path": "Claim.item.unitPrice",
"min": 0,
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.unitPrice"
},
"isSummary": true
}, {
"path": "Claim.item.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.factor"
},
"isSummary": true
}, {
"path": "Claim.item.points",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point.",
"isModifier": false,
"short": "Difficulty scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.points"
},
"isSummary": true
}, {
"path": "Claim.item.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Total item cost",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.net"
},
"isSummary": true
}, {
"path": "Claim.item.udi",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"definition": "List of Unique Device Identifiers associated with this line item.",
"isModifier": false,
"short": "Unique Device Identifier",
"type": [ {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.udi"
},
"isSummary": true
}, {
"path": "Claim.item.bodySite",
"min": 0,
"definition": "Physical service site on the patient (limb, tooth, etc).",
"isModifier": false,
"short": "Service Location",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The code for the teeth, quadrant, sextant and arch",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/tooth"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.bodySite"
},
"isSummary": true
}, {
"path": "Claim.item.subSite",
"min": 0,
"definition": "A region or surface of the site, eg. limb region or tooth surface(s).",
"isModifier": false,
"short": "Service Sub-location",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The code for the tooth surface and surface combinations",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/surface"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.subSite"
},
"isSummary": true
}, {
"path": "Claim.item.detail",
"min": 0,
"definition": "Second tier of goods and services.",
"isModifier": false,
"short": "Additional items",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Detail"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail"
},
"isSummary": true
}, {
"path": "Claim.item.detail.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.item.detail.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.item.detail.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.item.detail.sequence",
"min": 1,
"definition": "A service line number.",
"isModifier": false,
"short": "Service instance",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.sequence"
},
"isSummary": true
}, {
"path": "Claim.item.detail.type",
"min": 1,
"definition": "The type of product or service.",
"isModifier": false,
"short": "Group or type of product or service",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Group, Service, Product.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-itemtype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.type"
},
"isSummary": true
}, {
"path": "Claim.item.detail.service",
"min": 1,
"definition": "If a grouping item then 'GROUP' otherwise it is a node therefore a code to indicate the Professional Service or Product supplied.",
"isModifier": false,
"short": "Additional item codes",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.service"
},
"isSummary": true
}, {
"path": "Claim.item.detail.programCode",
"min": 0,
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Program specific reason codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.programCode"
},
"isSummary": true
}, {
"path": "Claim.item.detail.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.quantity"
},
"isSummary": true
}, {
"path": "Claim.item.detail.unitPrice",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.unitPrice"
},
"isSummary": true
}, {
"path": "Claim.item.detail.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.factor"
},
"isSummary": true
}, {
"path": "Claim.item.detail.points",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point.",
"isModifier": false,
"short": "Difficulty scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.points"
},
"isSummary": true
}, {
"path": "Claim.item.detail.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Total additional item cost",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.net"
},
"isSummary": true
}, {
"path": "Claim.item.detail.udi",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"definition": "List of Unique Device Identifiers associated with this line item.",
"isModifier": false,
"short": "Unique Device Identifier",
"type": [ {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.udi"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail",
"min": 0,
"definition": "Third tier of goods and services.",
"isModifier": false,
"short": "Additional items",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "SubDetail"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.subDetail"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.item.detail.subDetail.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.item.detail.subDetail.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.sequence",
"min": 1,
"definition": "A service line number.",
"isModifier": false,
"short": "Service instance",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.sequence"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.type",
"min": 1,
"definition": "The type of product or service.",
"isModifier": false,
"short": "Type of product or service",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Group, Service, Product.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-itemtype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.type"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.service",
"min": 1,
"definition": "The fee for an addittional service or product or charge.",
"isModifier": false,
"short": "Additional item codes",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.service"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.programCode",
"min": 0,
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Program specific reason codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.subDetail.programCode"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.quantity"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.unitPrice",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The fee for an addittional service or product or charge.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.unitPrice"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.factor"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.points",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point.",
"isModifier": false,
"short": "Difficulty scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.points"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Net additional item cost",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.net"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.udi",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"definition": "List of Unique Device Identifiers associated with this line item.",
"isModifier": false,
"short": "Unique Device Identifier",
"type": [ {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.subDetail.udi"
},
"isSummary": true
}, {
"path": "Claim.item.prosthesis",
"min": 0,
"definition": "The materials and placement date of prior fixed prosthesis.",
"isModifier": false,
"short": "Prosthetic details",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Prosthesis"
} ],
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.prosthesis"
},
"isSummary": true
}, {
"path": "Claim.item.prosthesis.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.item.prosthesis.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.item.prosthesis.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.item.prosthesis.initial",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Indicates whether this is the initial placement of a fixed prosthesis.",
"isModifier": false,
"short": "Is this the initial service",
"type": [ {
"code": "boolean"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.prosthesis.initial"
},
"isSummary": true
}, {
"path": "Claim.item.prosthesis.priorDate",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Date of the initial placement.",
"isModifier": false,
"short": "Initial service Date",
"type": [ {
"code": "date"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.prosthesis.priorDate"
},
"isSummary": true
}, {
"path": "Claim.item.prosthesis.priorMaterial",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Material of the prior denture or bridge prosthesis. (Oral).",
"isModifier": false,
"short": "Prosthetic Material",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Material of the prior denture or bridge prosthesis. (Oral)",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/oral-prosthodontic-material"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.prosthesis.priorMaterial"
},
"isSummary": true
}, {
"path": "Claim.total",
"min": 0,
"definition": "The total value of the claim.",
"isModifier": false,
"short": "Total claim cost",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.total"
},
"isSummary": true
}, {
"path": "Claim.additionalMaterial",
"min": 0,
"definition": "Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission.",
"isModifier": false,
"short": "Additional supporting materials and documents",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/additionalmaterials"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.additionalMaterial"
},
"isSummary": true
}, {
"path": "Claim.missingTeeth",
"requirements": "The list of missing teeth may influence the adjudication of services for example with Bridges.",
"min": 0,
"definition": "A list of teeth which would be expected but are not found due to having been previously extracted or for other reasons.",
"isModifier": false,
"short": "Only if type = oral",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "MissingTeeth"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.missingTeeth"
},
"isSummary": true
}, {
"path": "Claim.missingTeeth.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references).",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"mustSupport": false,
"representation": [ "xmlAttr" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "Claim.missingTeeth.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "Claim.missingTeeth.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"comments": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"mustSupport": false,
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"path": "Claim.missingTeeth.tooth",
"requirements": "Provides the tooth number of the missing tooth.",
"min": 1,
"definition": "The code identifying which tooth is missing.",
"isModifier": false,
"short": "Tooth Code",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The codes for the teeth, subset of OralSites",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/teeth"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.missingTeeth.tooth"
},
"isSummary": true
}, {
"path": "Claim.missingTeeth.reason",
"requirements": "Provides the reason for the missing tooth.",
"min": 0,
"definition": "Missing reason may be: E-extraction, O-other.",
"isModifier": false,
"short": "Indicates whether it was extracted or other reason",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Reason codes for the missing teeth",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.missingTeeth.reason"
},
"isSummary": true
}, {
"path": "Claim.missingTeeth.extractionDate",
"requirements": "Some services and adjudications require this information.",
"min": 0,
"definition": "The date of the extraction either known from records or patient reported estimate.",
"isModifier": false,
"short": "Date tooth was extracted if known",
"type": [ {
"code": "date"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.missingTeeth.extractionDate"
},
"isSummary": true
} ]
},
"status": "draft",
"id": "39b2e30d-e7b8-4cf4-904b-cd674ca02eb0",
"kind": "resource",
"url": "http://hl7.org/fhir/StructureDefinition/Claim",
"version": null,
"differential": {
"element": [ {
"path": "Claim",
"min": 0,
"definition": "A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.",
"isModifier": false,
"short": "Claim, Pre-determination or Pre-authorization",
"mapping": [ {
"map": "financial.billing",
"identity": "w5"
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim"
},
"isSummary": true
}, {
"path": "Claim.type",
"min": 1,
"definition": "The category of claim.",
"isModifier": false,
"short": "institutional | oral | pharmacy | professional | vision",
"comments": "Affects which fields and value sets are used.",
"type": [ {
"code": "code"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "The type or discipline-style of the claim",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-type-link"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.type"
},
"isSummary": true
}, {
"path": "Claim.subType",
"min": 0,
"definition": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.",
"isModifier": false,
"short": "Finer grained claim type information",
"comments": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "A more granulat claim typecode",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-subtype"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.subType"
},
"isSummary": true
}, {
"path": "Claim.identifier",
"min": 0,
"definition": "The business identifier for the instance: claim number, pre-determination or pre-authorization number.",
"isModifier": false,
"short": "Claim number",
"type": [ {
"code": "Identifier"
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.identifier"
},
"isSummary": true
}, {
"path": "Claim.ruleset",
"min": 0,
"definition": "The version of the specification on which this instance relies.",
"isModifier": false,
"short": "Current specification followed",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
},
"alias": [ "BusinessVersion" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.ruleset"
},
"isSummary": true
}, {
"path": "Claim.originalRuleset",
"min": 0,
"definition": "The version of the specification from which the original instance was created.",
"isModifier": false,
"short": "Original specification followed",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
},
"alias": [ "OriginalBusinessVersion" ],
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.originalRuleset"
},
"isSummary": true
}, {
"path": "Claim.created",
"min": 0,
"definition": "The date when the enclosed suite of services were performed or completed.",
"isModifier": false,
"short": "Creation date",
"type": [ {
"code": "dateTime"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.created"
},
"isSummary": true
}, {
"path": "Claim.billablePeriod",
"min": 0,
"definition": "The billable period for which charges are being submitted.",
"isModifier": false,
"short": "Period for charge submission",
"type": [ {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.billablePeriod"
},
"isSummary": true
}, {
"path": "Claim.target[x]",
"min": 0,
"definition": "Insurer Identifier, typical BIN number (6 digit).",
"isModifier": false,
"short": "Insurer",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.target[x]"
},
"isSummary": true
}, {
"path": "Claim.provider[x]",
"min": 0,
"definition": "The provider which is responsible for the bill, claim pre-determination, pre-authorization.",
"isModifier": false,
"short": "Responsible provider",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.provider[x]"
},
"isSummary": true
}, {
"path": "Claim.organization[x]",
"min": 0,
"definition": "The organization which is responsible for the bill, claim pre-determination, pre-authorization.",
"isModifier": false,
"short": "Responsible organization",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.organization[x]"
},
"isSummary": true
}, {
"path": "Claim.use",
"min": 0,
"definition": "Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).",
"isModifier": false,
"short": "complete | proposed | exploratory | other",
"type": [ {
"code": "code"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Complete, proposed, exploratory, other",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-use-link"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.use"
},
"isSummary": true
}, {
"path": "Claim.priority",
"min": 0,
"definition": "Immediate (STAT), best effort (NORMAL), deferred (DEFER).",
"isModifier": false,
"short": "Desired processing priority",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The timeliness with which processing is required: STAT, normal, Deferred",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/process-priority"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.priority"
},
"isSummary": true
}, {
"path": "Claim.fundsReserve",
"min": 0,
"definition": "In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.",
"isModifier": false,
"short": "Funds requested to be reserved",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fundsreserve"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.fundsReserve"
},
"isSummary": true
}, {
"path": "Claim.enterer[x]",
"min": 0,
"definition": "Person who created the invoice/claim/pre-determination or pre-authorization.",
"isModifier": false,
"short": "Author",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.enterer[x]"
},
"isSummary": true
}, {
"path": "Claim.facility[x]",
"min": 0,
"definition": "Facility where the services were provided.",
"isModifier": false,
"short": "Servicing Facility",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.facility[x]"
},
"isSummary": true
}, {
"path": "Claim.related",
"min": 0,
"definition": "Other claims which are related to this claim such as prior claim versions or for related services.",
"isModifier": false,
"short": "Related Claims which may be revelant to processing this claimn",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "RelatedClaims"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.related"
},
"isSummary": true
}, {
"path": "Claim.related.claim[x]",
"min": 0,
"definition": "Other claims which are related to this claim such as prior claim versions or for related services.",
"isModifier": false,
"short": "Reference to the related claim",
"comments": "Do we need a relationship code?",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Claim" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.related.claim[x]"
},
"isSummary": true
}, {
"path": "Claim.related.relationship",
"min": 0,
"definition": "For example prior or umbrella.",
"isModifier": false,
"short": "How the reference claim is related",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Relationship of this claim to a related Claim",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/related-claim-relationship"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.related.relationship"
},
"isSummary": true
}, {
"path": "Claim.related.reference",
"min": 0,
"definition": "An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # .",
"isModifier": false,
"short": "Related file or case reference",
"type": [ {
"code": "Identifier"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.related.reference"
},
"isSummary": true
}, {
"path": "Claim.prescription[x]",
"requirements": "For type=Pharmacy and Vision only.",
"min": 0,
"definition": "Prescription to support the dispensing of Pharmacy or Vision products.",
"isModifier": false,
"short": "Prescription",
"comments": "Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence.",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/MedicationOrder" ]
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/VisionPrescription" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.prescription[x]"
},
"isSummary": true
}, {
"path": "Claim.originalPrescription[x]",
"min": 0,
"definition": "Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products.",
"isModifier": false,
"short": "Original Prescription",
"comments": "as above.",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/MedicationOrder" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.originalPrescription[x]"
},
"isSummary": true
}, {
"path": "Claim.payee",
"min": 0,
"definition": "The party to be reimbursed for the services.",
"isModifier": false,
"short": "Party to be paid any benefits payable",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Payee"
} ],
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.payee"
},
"isSummary": true
}, {
"path": "Claim.payee.type",
"min": 1,
"definition": "Type of Party to be reimbursed: Subscriber, provider, other.",
"isModifier": false,
"short": "Type of party: Subscriber, Provider, other",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "A code for the party to be reimbursed.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/payeetype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.payee.type"
},
"isSummary": true
}, {
"path": "Claim.payee.party[x]",
"min": 0,
"definition": "Party to be reimbursed: Subscriber, provider, other.",
"isModifier": false,
"short": "Party to receive the payable",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.payee.party[x]"
},
"isSummary": true
}, {
"path": "Claim.referral[x]",
"min": 0,
"definition": "The referral resource which lists the date, practitioner, reason and other supporting information.",
"isModifier": false,
"short": "Treatment Referral",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/ReferralRequest" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.referral[x]"
},
"isSummary": true
}, {
"path": "Claim.occurrenceCode",
"min": 0,
"definition": "**Insert definition of Occurrence codes.",
"isModifier": false,
"short": "Occurrence Codes",
"comments": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Occurrence codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/occurrence-codes"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.occurrenceCode"
},
"isSummary": true
}, {
"path": "Claim.occurenceSpanCode",
"min": 0,
"definition": "**Insert definition of Occurrence Span codes.",
"isModifier": false,
"short": "Occurrence Span Codes",
"comments": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Occurrence Span codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/occurrence-span-codes"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.occurenceSpanCode"
},
"isSummary": true
}, {
"path": "Claim.valueCode",
"min": 0,
"definition": "**Insert definition of Value codes.",
"isModifier": false,
"short": "Value Codes",
"comments": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Value code",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/value-codes"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.valueCode"
},
"isSummary": true
}, {
"path": "Claim.diagnosis",
"min": 0,
"definition": "Ordered list of patient diagnosis for which care is sought.",
"isModifier": false,
"short": "Diagnosis",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Diagnosis"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.diagnosis"
},
"isSummary": true
}, {
"path": "Claim.diagnosis.sequence",
"requirements": "Required to maintain order of the diagnoses.",
"min": 1,
"definition": "Sequence of diagnosis which serves to order and provide a link.",
"isModifier": false,
"short": "Number to covey order of diagnosis",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.diagnosis.sequence"
},
"isSummary": true
}, {
"path": "Claim.diagnosis.diagnosis",
"requirements": "Required to adjudicate services rendered to condition presented.",
"min": 1,
"definition": "The diagnosis.",
"isModifier": false,
"short": "Patient's list of diagnosis",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "ICD10 Diagnostic codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/icd-10"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.diagnosis.diagnosis"
},
"isSummary": true
}, {
"path": "Claim.procedure",
"min": 0,
"definition": "Ordered list of patient procedures performed to support the adjudication.",
"isModifier": false,
"short": "Procedures performed",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Procedure"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.procedure"
},
"isSummary": true
}, {
"path": "Claim.procedure.sequence",
"requirements": "Required to maintain order of the procudures.",
"min": 1,
"definition": "Sequence of procedures which serves to order and provide a link.",
"isModifier": false,
"short": "Procedure sequence for reference",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.procedure.sequence"
},
"isSummary": true
}, {
"path": "Claim.procedure.date",
"requirements": "Required to adjudicate services rendered.",
"min": 0,
"definition": "Date and optionally time the procedure was performed .",
"isModifier": false,
"short": "When the procedure was performed",
"comments": "SB DateTime??",
"type": [ {
"code": "dateTime"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.procedure.date"
},
"isSummary": true
}, {
"path": "Claim.procedure.procedure[x]",
"requirements": "Required to adjudicate services rendered.",
"min": 1,
"definition": "The procedure code.",
"isModifier": false,
"short": "Patient's list of procedures performed",
"type": [ {
"code": "Coding"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Procedure" ]
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "ICD10 Procedure codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/icd-10-procedures"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.procedure.procedure[x]"
},
"isSummary": true
}, {
"path": "Claim.specialCondition",
"min": 0,
"definition": "List of special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication.",
"isModifier": false,
"short": "List of special Conditions",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Patient conditions and symptoms",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-conditions"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.specialCondition"
},
"isSummary": true
}, {
"path": "Claim.patient[x]",
"min": 1,
"definition": "Patient Resource.",
"isModifier": false,
"short": "The subject of the Products and Services",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.patient[x]"
},
"isSummary": true
}, {
"path": "Claim.coverage",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"definition": "Financial instrument by which payment information for health care.",
"isModifier": false,
"short": "Insurance or medical plan",
"mapping": [ {
"map": "Coverage",
"identity": "rim"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Coverage"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.coverage"
},
"isSummary": true
}, {
"path": "Claim.coverage.sequence",
"requirements": "To maintain order of the coverages.",
"min": 1,
"definition": "A service line item.",
"isModifier": false,
"short": "Service instance identifier",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.sequence"
},
"isSummary": true
}, {
"path": "Claim.coverage.focal",
"requirements": "To identify which coverage is being adjudicated.",
"min": 1,
"definition": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
"isModifier": false,
"short": "Is the focal Coverage",
"type": [ {
"code": "boolean"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.focal"
},
"isSummary": true
}, {
"path": "Claim.coverage.coverage[x]",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min": 1,
"definition": "Reference to the program or plan identification, underwriter or payor.",
"isModifier": false,
"short": "Insurance information",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.coverage[x]"
},
"isSummary": true
}, {
"path": "Claim.coverage.businessArrangement",
"min": 0,
"definition": "The contract number of a business agreement which describes the terms and conditions.",
"isModifier": false,
"short": "Business agreement",
"type": [ {
"code": "string"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.businessArrangement"
},
"isSummary": true
}, {
"path": "Claim.coverage.preAuthRef",
"requirements": "To provide any pre=determination or prior authorization reference.",
"min": 0,
"definition": "A list of references from the Insurer to which these services pertain.",
"isModifier": false,
"short": "Pre-Authorization/Determination Reference",
"type": [ {
"code": "string"
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.coverage.preAuthRef"
},
"isSummary": true
}, {
"path": "Claim.coverage.claimResponse",
"requirements": "Used by downstream payers to determine what balance remains and the net payable.",
"min": 0,
"definition": "The Coverages adjudication details.",
"isModifier": false,
"short": "Adjudication results",
"type": [ {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/ClaimResponse" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.claimResponse"
},
"isSummary": true
}, {
"path": "Claim.coverage.originalRuleset",
"requirements": "Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated.",
"min": 0,
"definition": "The style (standard) and version of the original material which was converted into this resource.",
"isModifier": false,
"short": "Original version",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The static and dynamic model to which contents conform, which may be business version or standard/version.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ruleset"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.coverage.originalRuleset"
},
"isSummary": true
}, {
"path": "Claim.accidentDate",
"requirements": "Coverage may be dependant on accidents.",
"min": 0,
"definition": "Date of an accident which these services are addressing.",
"isModifier": false,
"short": "When the accident occurred",
"type": [ {
"code": "date"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.accidentDate"
},
"isSummary": true
}, {
"path": "Claim.accidentType",
"requirements": "Coverage may be dependant on the type of accident.",
"min": 0,
"definition": "Type of accident: work, auto, etc.",
"isModifier": false,
"short": "The nature of the accident",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Type of accident: work place, auto, etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/v3-ActIncidentCode"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.accidentType"
},
"isSummary": true
}, {
"path": "Claim.accidentLocation[x]",
"min": 0,
"definition": "Accident Place.",
"isModifier": false,
"short": "Accident Place",
"type": [ {
"code": "Address"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.accidentLocation[x]"
},
"isSummary": true
}, {
"path": "Claim.interventionException",
"requirements": "Coverage may be modified based on exception information provided.",
"min": 0,
"definition": "A list of intervention and exception codes which may influence the adjudication of the claim.",
"isModifier": false,
"short": "Intervention and exception code (Pharma)",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Intervention and exception codes (Pharm)",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/intervention"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.interventionException"
},
"isSummary": true
}, {
"path": "Claim.onset",
"min": 0,
"definition": "Period, start and last dates of aspects of the Condition or related services.",
"isModifier": false,
"short": "Condition related Onset related dates and codes",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Onset"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.onset"
},
"isSummary": true
}, {
"path": "Claim.onset.time[x]",
"min": 0,
"definition": "The start or start and end dates for the treatable condition.",
"isModifier": false,
"short": "Illness, injury or treatable condition date",
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.onset.time[x]"
},
"isSummary": true
}, {
"path": "Claim.onset.type",
"min": 0,
"definition": "Onset typifications eg. Start of pregnancy, start of illnes, etc.",
"isModifier": false,
"short": "Onset of what",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Condition related start, end and period codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-onsettype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.onset.type"
},
"isSummary": true
}, {
"path": "Claim.employmentImpacted",
"min": 0,
"definition": "The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).",
"isModifier": false,
"short": "Period unable to work",
"type": [ {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.employmentImpacted"
},
"isSummary": true
}, {
"path": "Claim.hospitalization",
"min": 0,
"definition": "The start and optional end dates of when the patient was confined to a treatment center.",
"isModifier": false,
"short": "Period in hospital",
"type": [ {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.hospitalization"
},
"isSummary": true
}, {
"path": "Claim.item",
"min": 0,
"definition": "First tier of goods and services.",
"isModifier": false,
"short": "Goods and Services",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Items"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item"
},
"isSummary": true
}, {
"path": "Claim.item.sequence",
"min": 1,
"definition": "A service line number.",
"isModifier": false,
"short": "Service instance",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.sequence"
},
"isSummary": true
}, {
"path": "Claim.item.type",
"min": 1,
"definition": "The type of product or service.",
"isModifier": false,
"short": "Group or type of product or service",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Group, Service, Product.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-itemtype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.type"
},
"isSummary": true
}, {
"path": "Claim.item.provider[x]",
"min": 0,
"definition": "The practitioner who is responsible for the services rendered to the patient.",
"isModifier": false,
"short": "Responsible practitioner",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.provider[x]"
},
"isSummary": true
}, {
"path": "Claim.item.supervisor[x]",
"min": 0,
"definition": "The practitioner who is supervising the work of the servicing provider(s).",
"isModifier": false,
"short": "Supervising Practitioner",
"type": [ {
"code": "Identifier"
}, {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.supervisor[x]"
},
"isSummary": true
}, {
"path": "Claim.item.providerQualification",
"min": 0,
"definition": "The qualification which is applicable for this service.",
"isModifier": false,
"short": "Type, classification or Specialization",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Provider professional qualifications",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/provider-qualification"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.providerQualification"
},
"isSummary": true
}, {
"path": "Claim.item.diagnosisLinkId",
"min": 0,
"definition": "Diagnosis applicable for this service or product line.",
"isModifier": false,
"short": "Applicable diagnoses",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.diagnosisLinkId"
},
"isSummary": true
}, {
"path": "Claim.item.service",
"min": 1,
"definition": "If a grouping item then 'GROUP' otherwise it is a node therefore a code to indicate the Professional Service or Product supplied.",
"isModifier": false,
"short": "Item Code",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.service"
},
"isSummary": true
}, {
"path": "Claim.item.serviceModifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Unusual circumstances which may influence adjudication.",
"isModifier": false,
"short": "Service/Product modifiers",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Factors which may influce adjudication of services",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-modifiers"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.serviceModifier"
},
"isSummary": true
}, {
"path": "Claim.item.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"isModifier": false,
"short": "Service/Product billing modifiers",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.modifier"
},
"isSummary": true
}, {
"path": "Claim.item.programCode",
"min": 0,
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Program specific reason codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.programCode"
},
"isSummary": true
}, {
"path": "Claim.item.serviced[x]",
"min": 0,
"definition": "The date or dates when the enclosed suite of services were performed or completed.",
"isModifier": false,
"short": "Date or dates of Service",
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.serviced[x]"
},
"isSummary": true
}, {
"path": "Claim.item.place",
"min": 0,
"definition": "Where the service was provided.",
"isModifier": false,
"short": "Place of service",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-place"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.place"
},
"isSummary": true
}, {
"path": "Claim.item.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.quantity"
},
"isSummary": true
}, {
"path": "Claim.item.unitPrice",
"min": 0,
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.unitPrice"
},
"isSummary": true
}, {
"path": "Claim.item.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.factor"
},
"isSummary": true
}, {
"path": "Claim.item.points",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point.",
"isModifier": false,
"short": "Difficulty scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.points"
},
"isSummary": true
}, {
"path": "Claim.item.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Total item cost",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.net"
},
"isSummary": true
}, {
"path": "Claim.item.udi",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"definition": "List of Unique Device Identifiers associated with this line item.",
"isModifier": false,
"short": "Unique Device Identifier",
"type": [ {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.udi"
},
"isSummary": true
}, {
"path": "Claim.item.bodySite",
"min": 0,
"definition": "Physical service site on the patient (limb, tooth, etc).",
"isModifier": false,
"short": "Service Location",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The code for the teeth, quadrant, sextant and arch",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/tooth"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.bodySite"
},
"isSummary": true
}, {
"path": "Claim.item.subSite",
"min": 0,
"definition": "A region or surface of the site, eg. limb region or tooth surface(s).",
"isModifier": false,
"short": "Service Sub-location",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The code for the tooth surface and surface combinations",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/surface"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.subSite"
},
"isSummary": true
}, {
"path": "Claim.item.detail",
"min": 0,
"definition": "Second tier of goods and services.",
"isModifier": false,
"short": "Additional items",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Detail"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail"
},
"isSummary": true
}, {
"path": "Claim.item.detail.sequence",
"min": 1,
"definition": "A service line number.",
"isModifier": false,
"short": "Service instance",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.sequence"
},
"isSummary": true
}, {
"path": "Claim.item.detail.type",
"min": 1,
"definition": "The type of product or service.",
"isModifier": false,
"short": "Group or type of product or service",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Group, Service, Product.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-itemtype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.type"
},
"isSummary": true
}, {
"path": "Claim.item.detail.service",
"min": 1,
"definition": "If a grouping item then 'GROUP' otherwise it is a node therefore a code to indicate the Professional Service or Product supplied.",
"isModifier": false,
"short": "Additional item codes",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.service"
},
"isSummary": true
}, {
"path": "Claim.item.detail.programCode",
"min": 0,
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Program specific reason codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.programCode"
},
"isSummary": true
}, {
"path": "Claim.item.detail.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.quantity"
},
"isSummary": true
}, {
"path": "Claim.item.detail.unitPrice",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.unitPrice"
},
"isSummary": true
}, {
"path": "Claim.item.detail.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.factor"
},
"isSummary": true
}, {
"path": "Claim.item.detail.points",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point.",
"isModifier": false,
"short": "Difficulty scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.points"
},
"isSummary": true
}, {
"path": "Claim.item.detail.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Total additional item cost",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.net"
},
"isSummary": true
}, {
"path": "Claim.item.detail.udi",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"definition": "List of Unique Device Identifiers associated with this line item.",
"isModifier": false,
"short": "Unique Device Identifier",
"type": [ {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.udi"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail",
"min": 0,
"definition": "Third tier of goods and services.",
"isModifier": false,
"short": "Additional items",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "SubDetail"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.subDetail"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.sequence",
"min": 1,
"definition": "A service line number.",
"isModifier": false,
"short": "Service instance",
"type": [ {
"code": "positiveInt"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.sequence"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.type",
"min": 1,
"definition": "The type of product or service.",
"isModifier": false,
"short": "Type of product or service",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "required",
"description": "Group, Service, Product.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-itemtype"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.type"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.service",
"min": 1,
"definition": "The fee for an addittional service or product or charge.",
"isModifier": false,
"short": "Additional item codes",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.service"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.programCode",
"min": 0,
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Program specific reason codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.subDetail.programCode"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.quantity"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.unitPrice",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The fee for an addittional service or product or charge.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.unitPrice"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.factor"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.points",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point.",
"isModifier": false,
"short": "Difficulty scaling factor",
"type": [ {
"code": "decimal"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.points"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Net additional item cost",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.detail.subDetail.net"
},
"isSummary": true
}, {
"path": "Claim.item.detail.subDetail.udi",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"definition": "List of Unique Device Identifiers associated with this line item.",
"isModifier": false,
"short": "Unique Device Identifier",
"type": [ {
"code": "Reference",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"mustSupport": false,
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.item.detail.subDetail.udi"
},
"isSummary": true
}, {
"path": "Claim.item.prosthesis",
"min": 0,
"definition": "The materials and placement date of prior fixed prosthesis.",
"isModifier": false,
"short": "Prosthetic details",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Prosthesis"
} ],
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.prosthesis"
},
"isSummary": true
}, {
"path": "Claim.item.prosthesis.initial",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Indicates whether this is the initial placement of a fixed prosthesis.",
"isModifier": false,
"short": "Is this the initial service",
"type": [ {
"code": "boolean"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.prosthesis.initial"
},
"isSummary": true
}, {
"path": "Claim.item.prosthesis.priorDate",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Date of the initial placement.",
"isModifier": false,
"short": "Initial service Date",
"type": [ {
"code": "date"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.prosthesis.priorDate"
},
"isSummary": true
}, {
"path": "Claim.item.prosthesis.priorMaterial",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Material of the prior denture or bridge prosthesis. (Oral).",
"isModifier": false,
"short": "Prosthetic Material",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Material of the prior denture or bridge prosthesis. (Oral)",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/oral-prosthodontic-material"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.item.prosthesis.priorMaterial"
},
"isSummary": true
}, {
"path": "Claim.total",
"min": 0,
"definition": "The total value of the claim.",
"isModifier": false,
"short": "Total claim cost",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Money" ]
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.total"
},
"isSummary": true
}, {
"path": "Claim.additionalMaterial",
"min": 0,
"definition": "Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission.",
"isModifier": false,
"short": "Additional supporting materials and documents",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/additionalmaterials"
}
},
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.additionalMaterial"
},
"isSummary": true
}, {
"path": "Claim.missingTeeth",
"requirements": "The list of missing teeth may influence the adjudication of services for example with Bridges.",
"min": 0,
"definition": "A list of teeth which would be expected but are not found due to having been previously extracted or for other reasons.",
"isModifier": false,
"short": "Only if type = oral",
"type": [ {
"code": "BackboneElement"
} ],
"mustSupport": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "MissingTeeth"
} ],
"max": "*",
"maxLength": 0,
"base": {
"max": "*",
"min": 0,
"path": "Claim.missingTeeth"
},
"isSummary": true
}, {
"path": "Claim.missingTeeth.tooth",
"requirements": "Provides the tooth number of the missing tooth.",
"min": 1,
"definition": "The code identifying which tooth is missing.",
"isModifier": false,
"short": "Tooth Code",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "The codes for the teeth, subset of OralSites",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/teeth"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.missingTeeth.tooth"
},
"isSummary": true
}, {
"path": "Claim.missingTeeth.reason",
"requirements": "Provides the reason for the missing tooth.",
"min": 0,
"definition": "Missing reason may be: E-extraction, O-other.",
"isModifier": false,
"short": "Indicates whether it was extracted or other reason",
"type": [ {
"code": "Coding"
} ],
"mustSupport": false,
"binding": {
"strength": "example",
"description": "Reason codes for the missing teeth",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.missingTeeth.reason"
},
"isSummary": true
}, {
"path": "Claim.missingTeeth.extractionDate",
"requirements": "Some services and adjudications require this information.",
"min": 0,
"definition": "The date of the extraction either known from records or patient reported estimate.",
"isModifier": false,
"short": "Date tooth was extracted if known",
"type": [ {
"code": "date"
} ],
"mustSupport": false,
"max": "1",
"maxLength": 0,
"base": {
"max": "1",
"min": 0,
"path": "Claim.missingTeeth.extractionDate"
},
"isSummary": true
} ]
},
"contact": [ {
"telecom": [ {
"rank": 1,
"value": "http://hl7.org/fhir",
"system": "other"
} ]
}, {
"telecom": [ {
"rank": 1,
"value": "http://www.hl7.org/Special/committees/fm/index.cfm",
"system": "other"
} ]
} ],
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource"
}