description: Profile of Claim for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
package_name: hl7.fhir.us.qicore
derivation: constraint
name: QICoreClaim
type: Claim
elements:
  patient:
    type: Reference
    short: (QI) The recipient of the products and services
    refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient']
    index: 3
  insurance:
    elements:
      coverage:
        type: Reference
        short: Insurance information
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage']
        index: 29
    required: [coverage]
  facility:
    type: Reference
    mustSupport: false
    refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location']
    index: 11
  diagnosis:
    short: (QI) Pertinent diagnosis information
    type: BackboneElement
    array: true
    index: 14
    elements:
      sequence: {type: positiveInt, short: (QI) Diagnosis instance identifier, index: 15}
      diagnosis:
        short: (QI) Nature of illness or problem
        choices: [diagnosisCodeableConcept, diagnosisReference]
        index: 17
      diagnosisCodeableConcept: {type: CodeableConcept, short: (QI) Nature of illness or problem, choiceOf: diagnosis, index: 18}
      diagnosisReference:
        type: Reference
        short: (QI) Nature of illness or problem
        choiceOf: diagnosis
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis']
        index: 19
      type:
        short: (QI) Timing or nature of the diagnosis
        type: CodeableConcept
        array: true
        binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosistype', bindingName: DiagnosisType}
        index: 20
      onAdmission:
        type: CodeableConcept
        short: (QI) Present on admission
        binding: {strength: required, valueSet: 'http://terminology.hl7.org/ValueSet/POAIndicators'}
        index: 21
  use: {short: (QI) claim | preauthorization | predetermination, index: 2}
  item:
    elements:
      encounter:
        type: Reference
        short: (QI) Encounters related to this billed item
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter']
        index: 30
  type: {short: (QI) category | discipline, index: 1}
  created: {short: (QI) Resource creation date, index: 5}
  procedure:
    short: (QI) Clinical procedures performed
    type: BackboneElement
    array: true
    index: 22
    elements:
      sequence: {type: positiveInt, short: (QI) Procedure instance identifier, isSummary: false, isModifier: false, index: 23}
      type:
        short: (QI) Category of Procedure
        type: CodeableConcept
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-procedure-type', bindingName: ProcedureType}
        index: 24
      procedure:
        short: (QI) Specific clinical procedure
        choices: [procedureCodeableConcept, procedureReference]
        index: 26
      procedureCodeableConcept: {type: CodeableConcept, short: (QI) Specific clinical procedure, choiceOf: procedure, index: 27}
      procedureReference:
        type: Reference
        short: (QI) Specific clinical procedure
        choiceOf: procedure
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure']
        index: 28
  referral:
    type: Reference
    mustSupport: false
    refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest']
    index: 10
  status:
    pattern: {type: code, value: active}
    short: (QI) active
    type: code
    index: 0
  payee:
    mustSupport: false
    index: 8
    elements:
      party:
        type: Reference
        mustSupport: false
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson']
        index: 9
  prescription:
    type: Reference
    short: (QI) Prescription authorizing services and products
    refers: ['http://hl7.org/fhir/StructureDefinition/VisionPrescription', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-devicerequest', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest']
    index: 7
  billablePeriod: {short: (QI) Relevant time frame for the claim, index: 4}
  provider:
    type: Reference
    short: (QI) Party responsible for the claim
    refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole']
    index: 6
  careTeam:
    mustSupport: false
    index: 12
    elements:
      provider:
        type: Reference
        mustSupport: false
        refers: ['http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner', 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitionerrole']
        index: 13
package_version: 7.0.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 7.0.0
required: [status, type, use]