description: MedNet Interface (MNI) - Claim Profile
package_name: swiss.mednet.fhir
derivation: constraint
name: MNIClaim
type: Claim
elements:
  patient:
    type: Reference
    short: Link to the patient concerned by the claim
    mustSupport: true
    refers: ['https://mednet.swiss/fhir/StructureDefinition/mni-patient']
    index: 34
  insurance:
    mustSupport: true
    index: 38
    elements:
      modifierExtension: {mustSupport: false, index: 39}
      sequence: {short: 'The sequence element in Claim.insurance is used to indicate the order of insurance coverage priority. It defines which insurance is primary, secondary, tertiary, etc., in situations where a patient has multiple active insurance policies. sequence = 1 it is the primary insurance', mustSupport: true, index: 40}
      focal: {short: indicates which insurance coverage is currently responsible for adjudicating (processing and paying) the claim, mustSupport: true, index: 41}
      coverage:
        type: Reference
        mustSupport: true
        refers: ['https://mednet.swiss/fhir/StructureDefinition/mni-coverage']
        index: 42
  use:
    short: Fixed value:claim
    pattern: {type: Code, value: claim}
    mustSupport: true
    index: 33
  item:
    mustSupport: true
    index: 46
    elements:
      modifierExtension: {mustSupport: false, index: 47}
      sequence: {short: unique line number to each item (service or product) listed in the claim, mustSupport: true, index: 48}
      category:
        short: 'Fixed category : TARDOC'
        mustSupport: true
        index: 49
        elements:
          coding:
            index: 50
            slicing:
              rules: open
              ordered: false
              discriminator:
              - {path: system, type: value}
              - {path: code, type: value}
              min: 1
              slices:
                TARDOC:
                  match: {system: 'http://forum-datenaustausch.ch/tariff', code: '007'}
                  schema:
                    mustSupport: true
                    _required: true
                    index: 51
                    elements:
                      system:
                        pattern: {type: Uri, value: 'http://forum-datenaustausch.ch/tariff'}
                        mustSupport: true
                        index: 52
                      code:
                        pattern: {type: Code, value: '007'}
                        mustSupport: true
                        index: 53
                      display:
                        pattern: {type: String, value: TARDOC}
                        mustSupport: true
                        index: 54
                    required: [system, code]
        required: [coding]
      productOrService:
        short: The tariff position
        mustSupport: true
        index: 55
        elements:
          coding:
            mustSupport: true
            index: 56
            elements:
              system:
                pattern: {type: Uri, value: 'http://forum-datenaustausch.ch/tariff/TMA'}
                mustSupport: true
                index: 57
              code: {short: The tariff position code, mustSupport: true, index: 58}
              display: {short: The tariff position corresponding text, mustSupport: true, index: 59}
            required: [system, code]
    required: [category]
  implicitRules: {mustSupport: false, index: 1}
  type:
    short: 1 (Ambulant/Ambulatoire/Outpatient) | 3 (stationär/Hospitalisé/Inpatient) | 9 (unbekannt/Inconnu/Unknown)
    binding: {strength: required, valueSet: 'http://fhir.ch/ig/ch-core/ValueSet/bfs-medstats-20-encounterclass'}
    mustSupport: true
    index: 32
  created: {short: The date or dateTime the claim has been created, mustSupport: true, index: 35}
  priority: {short: 'stat (Immediately in real time) | normal (With best effort) | deferred (Later, when possible)', mustSupport: true, index: 37}
  accident:
    mustSupport: true
    index: 43
    elements:
      modifierExtension: {mustSupport: false, index: 44}
      date: {mustSupport: true, index: 45}
  status:
    short: Fixed value:active. Only active claim data are usefull
    pattern: {type: Code, value: active}
    mustSupport: true
    index: 31
  id: {short: 'The id is unique within the space of all resources of the same type on the same server It can be any combination of upper- or lower-case ASCII letters ''A''..''Z'', and ''a''..''z'', numerals (''0''..''9''), ''-'' and ''.'' with a length limit of 64 characters. (This might be an integer, an un-prefixed OID, UUID or any other identifier pattern that meets these constraints.)', index: 0}
  identifier:
    mustSupport: true
    index: 3
    slicing:
      rules: open
      discriminator:
      - {path: system, type: value}
      - {path: type.coding.system, type: value}
      - {path: type.coding.code, type: value}
      min: null
      slices:
        accident:
          match:
            system: null
            type:
              coding: {system: 'https://mednet.swiss/fhir/CodeSystem/mni-identifierType', code: accident-id}
          schema:
            short: accident identifiers
            mustSupport: true
            index: 4
            elements:
              use: {index: 5}
              type:
                mustSupport: true
                index: 6
                elements:
                  coding:
                    mustSupport: true
                    index: 7
                    elements:
                      system:
                        pattern: {type: Uri, value: 'https://mednet.swiss/fhir/CodeSystem/mni-identifierType'}
                        mustSupport: true
                        index: 8
                      code:
                        pattern: {type: Code, value: accident-id}
                        mustSupport: true
                        index: 9
                      display:
                        pattern: {type: String, value: accident identifier}
                        mustSupport: true
                        index: 10
                    required: [system, code]
                required: [coding]
              system: {short: 'Uri that defines the Software that delivers the accident ID. for example https://mysoftware.ch/accidentDB/123456', mustSupport: true, index: 11}
              value: {mustSupport: true, index: 12}
            required: [value, type]
        disability:
          match:
            system: null
            type:
              coding: {system: 'https://mednet.swiss/fhir/CodeSystem/mni-identifierType', code: disability-id}
          schema:
            short: disability identifiers
            mustSupport: true
            index: 13
            elements:
              use: {index: 14}
              type:
                mustSupport: true
                index: 15
                elements:
                  coding:
                    mustSupport: true
                    index: 16
                    elements:
                      system:
                        pattern: {type: Uri, value: 'https://mednet.swiss/fhir/CodeSystem/mni-identifierType'}
                        mustSupport: true
                        index: 17
                      code:
                        pattern: {type: Code, value: disability-id}
                        mustSupport: true
                        index: 18
                      display:
                        pattern: {type: String, value: disability identifier}
                        mustSupport: true
                        index: 19
                    required: [system, code]
                required: [coding]
              system: {short: 'Uri that defines the Software that delivers the disability ID. for example https://mysoftware.ch/disabilityDB/123456', mustSupport: true, index: 20}
              value: {mustSupport: true, index: 21}
            required: [value, type]
        militaryIncident:
          match:
            system: null
            type:
              coding: {system: 'https://mednet.swiss/fhir/CodeSystem/mni-identifierType', code: militaryIncident-id}
          schema:
            short: militaryIncident identifiers
            mustSupport: true
            index: 22
            elements:
              use: {index: 23}
              type:
                mustSupport: true
                index: 24
                elements:
                  coding:
                    mustSupport: true
                    index: 25
                    elements:
                      system:
                        pattern: {type: Uri, value: 'https://mednet.swiss/fhir/CodeSystem/mni-identifierType'}
                        mustSupport: true
                        index: 26
                      code:
                        pattern: {type: Code, value: militaryIncident-id}
                        mustSupport: true
                        index: 27
                      display:
                        pattern: {type: String, value: military incident identifier}
                        mustSupport: true
                        index: 28
                    required: [system, code]
                required: [coding]
              system: {short: 'Uri that defines the Software that delivers the militaryIncident ID. for example https://mysoftware.ch/militaryIncidentDB/123456', mustSupport: true, index: 29}
              value: {mustSupport: true, index: 30}
            required: [value, type]
  provider:
    type: Reference
    short: The mednet practitioner responsible for the claim
    mustSupport: true
    refers: ['https://mednet.swiss/fhir/StructureDefinition/mni-practitionerRole']
    index: 36
  modifierExtension: {mustSupport: false, index: 2}
package_version: 0.19.0
class: profile
kind: resource
url: https://mednet.swiss/fhir/StructureDefinition/mni-claim
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 0.19.0