description: A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.
package_name: hl7.fhir.r5.examples
derivation: specialization
name: Claim
type: Claim
elements:
  patient:
    isModifier: false
    short: The recipient of the products and services
    refers: ['http://hl7.org/fhir/StructureDefinition/Patient']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 6
  insurance:
    isModifier: false
    short: Patient insurance information
    index: 73
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequence: {isModifier: false, short: Insurance instance identifier, type: positiveInt, mustSupport: false, isSummary: true, index: 74}
      focal: {isModifier: false, short: Coverage to be used for adjudication, type: boolean, mustSupport: false, isSummary: true, index: 75}
      identifier: {isModifier: false, short: Pre-assigned Claim number, type: Identifier, mustSupport: false, isSummary: false, index: 76}
      coverage:
        isModifier: false
        short: Insurance information
        refers: ['http://hl7.org/fhir/StructureDefinition/Coverage']
        type: Reference
        mustSupport: false
        isSummary: true
        index: 77
      businessArrangement: {isModifier: false, short: Additional provider contract number, type: string, mustSupport: false, isSummary: false, index: 78}
      preAuthRef: {isModifier: false, short: Prior authorization reference number, type: string, mustSupport: false, array: true, isSummary: false, index: 79}
      claimResponse:
        isModifier: false
        short: Adjudication results
        refers: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 80
    required: [coverage, focal, sequence]
    isSummary: true
  facility:
    isModifier: false
    short: Servicing facility
    refers: ['http://hl7.org/fhir/StructureDefinition/Location', 'http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    mustSupport: false
    isSummary: false
    index: 25
  diagnosis:
    isModifier: false
    short: Pertinent diagnosis information
    index: 56
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequence: {isModifier: false, short: Diagnosis instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 57}
      diagnosis:
        isModifier: false
        short: Nature of illness or problem
        mustSupport: false
        choices: [diagnosisCodeableConcept, diagnosisReference]
        isSummary: false
        index: 59
      diagnosisCodeableConcept: {isModifier: false, short: Nature of illness or problem, type: CodeableConcept, mustSupport: false, choiceOf: diagnosis, isSummary: false, index: 60}
      diagnosisReference:
        isModifier: false
        short: Nature of illness or problem
        index: 61
        refers: ['http://hl7.org/fhir/StructureDefinition/Condition']
        type: Reference
        mustSupport: false
        choiceOf: diagnosis
        isSummary: false
      type:
        isModifier: false
        short: Timing or nature of the diagnosis
        type: CodeableConcept
        mustSupport: false
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosistype'}
        isSummary: false
        index: 62
      onAdmission:
        isModifier: false
        short: Present on admission
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission'}
        isSummary: false
        index: 63
    required: [diagnosisReference, diagnosis, diagnosisCodeableConcept, sequence]
    isSummary: false
  enterer:
    isModifier: false
    short: Author of the claim
    refers: ['http://hl7.org/fhir/StructureDefinition/Patient', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson']
    type: Reference
    mustSupport: false
    isSummary: false
    index: 9
  supportingInfo:
    isModifier: false
    short: Supporting information
    index: 39
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      category:
        isModifier: false
        short: Classification of the supplied information
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-informationcategory'}
        isSummary: false
        index: 41
      valueReference:
        isModifier: false
        short: Data to be provided
        refers: ['http://hl7.org/fhir/StructureDefinition/Resource']
        type: Reference
        mustSupport: false
        choiceOf: value
        isSummary: false
        index: 53
      valueIdentifier: {isModifier: false, short: Data to be provided, type: Identifier, mustSupport: false, choiceOf: value, isSummary: false, index: 54}
      valueQuantity: {isModifier: false, short: Data to be provided, type: Quantity, mustSupport: false, choiceOf: value, isSummary: false, index: 51}
      timingPeriod: {isModifier: false, short: When it occurred, type: Period, mustSupport: false, choiceOf: timing, isSummary: false, index: 46}
      value:
        isModifier: false
        short: Data to be provided
        mustSupport: false
        choices: [valueBoolean, valueString, valueQuantity, valueAttachment, valueReference, valueIdentifier]
        isSummary: false
        index: 48
      valueString: {isModifier: false, short: Data to be provided, type: string, mustSupport: false, choiceOf: value, isSummary: false, index: 50}
      valueBoolean: {isModifier: false, short: Data to be provided, type: boolean, mustSupport: false, choiceOf: value, isSummary: false, index: 49}
      reason:
        isModifier: false
        short: Explanation for the information
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/missing-tooth-reason'}
        isSummary: false
        index: 55
      timing:
        isModifier: false
        short: When it occurred
        mustSupport: false
        choices: [timingDate, timingPeriod]
        isSummary: false
        index: 44
      sequence: {isModifier: false, short: Information instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 40}
      code:
        isModifier: false
        short: Type of information
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-exception'}
        isSummary: false
        index: 42
      timingDate: {isModifier: false, short: When it occurred, type: date, mustSupport: false, choiceOf: timing, isSummary: false, index: 45}
      valueAttachment: {isModifier: false, short: Data to be provided, type: Attachment, mustSupport: false, choiceOf: value, isSummary: false, index: 52}
    required: [sequence, category]
    isSummary: false
  encounter:
    isModifier: false
    short: Encounters associated with the listed treatments
    refers: ['http://hl7.org/fhir/StructureDefinition/Encounter']
    type: Reference
    mustSupport: false
    array: true
    isSummary: false
    index: 24
  use:
    isModifier: false
    short: claim | preauthorization | predetermination
    type: code
    mustSupport: false
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/claim-use|5.0.0-draft-final'}
    isSummary: true
    index: 5
  traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 1}
  item:
    isModifier: false
    short: Product or service provided
    index: 89
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      category:
        isModifier: false
        short: Benefit classification
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
        isSummary: false
        index: 97
      diagnosisSequence: {isModifier: false, short: Applicable diagnoses, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 93}
      procedureSequence: {isModifier: false, short: Applicable procedures, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 94}
      locationAddress: {isModifier: false, short: Place of service or where product was supplied, type: Address, mustSupport: false, choiceOf: location, isSummary: false, index: 110}
      request:
        isModifier: false
        short: Request or Referral for Service
        refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/NutritionOrder', 'http://hl7.org/fhir/StructureDefinition/ServiceRequest', 'http://hl7.org/fhir/StructureDefinition/SupplyRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription']
        type: Reference
        mustSupport: false
        array: true
        isSummary: false
        index: 100
      modifier:
        isModifier: false
        short: Product or service billing modifiers
        type: CodeableConcept
        mustSupport: false
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
        isSummary: false
        index: 101
      revenue:
        isModifier: false
        short: Revenue or cost center code
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'}
        isSummary: false
        index: 96
      encounter:
        isModifier: false
        short: Encounters associated with the listed treatments
        refers: ['http://hl7.org/fhir/StructureDefinition/Encounter']
        type: Reference
        mustSupport: false
        array: true
        isSummary: false
        index: 122
      productOrServiceEnd:
        isModifier: false
        short: End of a range of codes
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
        isSummary: false
        index: 99
      traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 91}
      locationCodeableConcept: {isModifier: false, short: Place of service or where product was supplied, type: CodeableConcept, mustSupport: false, choiceOf: location, isSummary: false, index: 109}
      net: {isModifier: false, short: Total item cost, type: Money, mustSupport: false, isSummary: false, index: 117}
      serviced:
        isModifier: false
        short: Date or dates of service or product delivery
        mustSupport: false
        choices: [servicedDate, servicedPeriod]
        isSummary: false
        index: 104
      tax: {isModifier: false, short: Total tax, type: Money, mustSupport: false, isSummary: false, index: 116}
      careTeamSequence: {isModifier: false, short: Applicable careTeam members, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 92}
      productOrService:
        isModifier: false
        short: Billing, service, product, or drug code
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
        isSummary: false
        index: 98
      locationReference:
        isModifier: false
        short: Place of service or where product was supplied
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        mustSupport: false
        choiceOf: location
        isSummary: false
        index: 111
      udi:
        isModifier: false
        short: Unique device identifier
        refers: ['http://hl7.org/fhir/StructureDefinition/Device']
        type: Reference
        mustSupport: false
        array: true
        isSummary: false
        index: 118
      informationSequence: {isModifier: false, short: Applicable exception and supporting information, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 95}
      programCode:
        isModifier: false
        short: Program the product or service is provided under
        type: CodeableConcept
        mustSupport: false
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'}
        isSummary: false
        index: 102
      factor: {isModifier: false, short: Price scaling factor, type: decimal, mustSupport: false, isSummary: false, index: 115}
      servicedDate: {isModifier: false, short: Date or dates of service or product delivery, type: date, mustSupport: false, choiceOf: serviced, isSummary: false, index: 105}
      sequence: {isModifier: false, short: Item instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 90}
      bodySite:
        isModifier: false
        short: Anatomical location
        index: 119
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          site:
            min: 1
            isModifier: false
            short: Location
            index: 120
            type: CodeableReference
            mustSupport: false
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/tooth'}
            isSummary: false
          subSite:
            isModifier: false
            short: Sub-location
            type: CodeableConcept
            mustSupport: false
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/surface'}
            isSummary: false
            index: 121
        required: [site]
        isSummary: false
      quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 113}
      location:
        isModifier: false
        short: Place of service or where product was supplied
        mustSupport: false
        choices: [locationCodeableConcept, locationAddress, locationReference]
        isSummary: false
        index: 108
      patientPaid: {isModifier: false, short: Paid by the patient, type: Money, mustSupport: false, isSummary: false, index: 112}
      unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 114}
      servicedPeriod: {isModifier: false, short: Date or dates of service or product delivery, type: Period, mustSupport: false, choiceOf: serviced, isSummary: false, index: 106}
      detail:
        isModifier: false
        short: Product or service provided
        index: 123
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          category:
            isModifier: false
            short: Benefit classification
            type: CodeableConcept
            mustSupport: false
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
            isSummary: false
            index: 127
          modifier:
            isModifier: false
            short: Service/Product billing modifiers
            type: CodeableConcept
            mustSupport: false
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
            isSummary: false
            index: 130
          revenue:
            isModifier: false
            short: Revenue or cost center code
            type: CodeableConcept
            mustSupport: false
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'}
            isSummary: false
            index: 126
          productOrServiceEnd:
            isModifier: false
            short: End of a range of codes
            type: CodeableConcept
            mustSupport: false
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
            isSummary: false
            index: 129
          traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 125}
          net: {isModifier: false, short: Total item cost, type: Money, mustSupport: false, isSummary: false, index: 137}
          tax: {isModifier: false, short: Total tax, type: Money, mustSupport: false, isSummary: false, index: 136}
          productOrService:
            isModifier: false
            short: Billing, service, product, or drug code
            type: CodeableConcept
            mustSupport: false
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
            isSummary: false
            index: 128
          udi:
            isModifier: false
            short: Unique device identifier
            refers: ['http://hl7.org/fhir/StructureDefinition/Device']
            type: Reference
            mustSupport: false
            array: true
            isSummary: false
            index: 138
          programCode:
            isModifier: false
            short: Program the product or service is provided under
            type: CodeableConcept
            mustSupport: false
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'}
            isSummary: false
            index: 131
          factor: {isModifier: false, short: Price scaling factor, type: decimal, mustSupport: false, isSummary: false, index: 135}
          sequence: {isModifier: false, short: Item instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 124}
          subDetail:
            isModifier: false
            short: Product or service provided
            index: 139
            type: BackboneElement
            mustSupport: false
            array: true
            elements:
              category:
                isModifier: false
                short: Benefit classification
                type: CodeableConcept
                mustSupport: false
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
                isSummary: false
                index: 143
              modifier:
                isModifier: false
                short: Service/Product billing modifiers
                type: CodeableConcept
                mustSupport: false
                array: true
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
                isSummary: false
                index: 146
              revenue:
                isModifier: false
                short: Revenue or cost center code
                type: CodeableConcept
                mustSupport: false
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'}
                isSummary: false
                index: 142
              productOrServiceEnd:
                isModifier: false
                short: End of a range of codes
                type: CodeableConcept
                mustSupport: false
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
                isSummary: false
                index: 145
              traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 141}
              net: {isModifier: false, short: Total item cost, type: Money, mustSupport: false, isSummary: false, index: 153}
              tax: {isModifier: false, short: Total tax, type: Money, mustSupport: false, isSummary: false, index: 152}
              productOrService:
                isModifier: false
                short: Billing, service, product, or drug code
                type: CodeableConcept
                mustSupport: false
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
                isSummary: false
                index: 144
              udi:
                isModifier: false
                short: Unique device identifier
                refers: ['http://hl7.org/fhir/StructureDefinition/Device']
                type: Reference
                mustSupport: false
                array: true
                isSummary: false
                index: 154
              programCode:
                isModifier: false
                short: Program the product or service is provided under
                type: CodeableConcept
                mustSupport: false
                array: true
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'}
                isSummary: false
                index: 147
              factor: {isModifier: false, short: Price scaling factor, type: decimal, mustSupport: false, isSummary: false, index: 151}
              sequence: {isModifier: false, short: Item instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 140}
              quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 149}
              patientPaid: {isModifier: false, short: Paid by the patient, type: Money, mustSupport: false, isSummary: false, index: 148}
              unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 150}
            required: [sequence]
            isSummary: false
          quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 133}
          patientPaid: {isModifier: false, short: Paid by the patient, type: Money, mustSupport: false, isSummary: false, index: 132}
          unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 134}
        required: [sequence]
        isSummary: false
    required: [sequence]
    isSummary: false
  type:
    isModifier: false
    short: Category or discipline
    type: CodeableConcept
    mustSupport: false
    binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/claim-type'}
    isSummary: true
    index: 3
  created: {isModifier: false, short: Resource creation date, type: dateTime, mustSupport: false, isSummary: true, index: 8}
  procedure:
    isModifier: false
    short: Clinical procedures performed
    index: 64
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequence: {isModifier: false, short: Procedure instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 65}
      type:
        isModifier: false
        short: Category of Procedure
        type: CodeableConcept
        mustSupport: false
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-procedure-type'}
        isSummary: false
        index: 66
      date: {isModifier: false, short: When the procedure was performed, type: dateTime, mustSupport: false, isSummary: false, index: 67}
      procedure:
        isModifier: false
        short: Specific clinical procedure
        mustSupport: false
        choices: [procedureCodeableConcept, procedureReference]
        isSummary: false
        index: 69
      procedureCodeableConcept: {isModifier: false, short: Specific clinical procedure, type: CodeableConcept, mustSupport: false, choiceOf: procedure, isSummary: false, index: 70}
      procedureReference:
        isModifier: false
        short: Specific clinical procedure
        index: 71
        refers: ['http://hl7.org/fhir/StructureDefinition/Procedure']
        type: Reference
        mustSupport: false
        choiceOf: procedure
        isSummary: false
      udi:
        isModifier: false
        short: Unique device identifier
        refers: ['http://hl7.org/fhir/StructureDefinition/Device']
        type: Reference
        mustSupport: false
        array: true
        isSummary: false
        index: 72
    required: [procedureReference, sequence, procedure, procedureCodeableConcept]
    isSummary: false
  related:
    isModifier: false
    short: Prior or corollary claims
    type: BackboneElement
    mustSupport: false
    array: true
    isSummary: false
    index: 14
    elements:
      claim:
        isModifier: false
        short: Reference to the related claim
        refers: ['http://hl7.org/fhir/StructureDefinition/Claim']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 15
      relationship:
        isModifier: false
        short: How the reference claim is related
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/related-claim-relationship'}
        isSummary: false
        index: 16
      reference: {isModifier: false, short: File or case reference, type: Identifier, mustSupport: false, isSummary: false, index: 17}
  referral:
    isModifier: false
    short: Treatment referral
    refers: ['http://hl7.org/fhir/StructureDefinition/ServiceRequest']
    type: Reference
    mustSupport: false
    isSummary: false
    index: 23
  diagnosisRelatedGroup:
    isModifier: false
    short: Package billing code
    type: CodeableConcept
    mustSupport: false
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup'}
    isSummary: false
    index: 26
  total: {isModifier: false, short: Total claim cost, type: Money, mustSupport: false, isSummary: false, index: 155}
  event:
    isModifier: false
    short: Event information
    index: 27
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      type:
        isModifier: false
        short: Specific event
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/datestype'}
        isSummary: false
        index: 28
      when:
        isModifier: false
        short: Occurance date or period
        mustSupport: false
        choices: [whenDateTime, whenPeriod]
        isSummary: false
        index: 30
      whenDateTime: {isModifier: false, short: Occurance date or period, type: dateTime, mustSupport: false, choiceOf: when, isSummary: false, index: 31}
      whenPeriod: {isModifier: false, short: Occurance date or period, type: Period, mustSupport: false, choiceOf: when, isSummary: false, index: 32}
    required: [when, type, whenDateTime, whenPeriod]
    isSummary: false
  insurer:
    isModifier: false
    short: Target
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 10
  fundsReserve:
    isModifier: false
    short: For whom to reserve funds
    type: CodeableConcept
    mustSupport: false
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/fundsreserve'}
    isSummary: false
    index: 13
  priority:
    isModifier: false
    short: Desired processing urgency
    type: CodeableConcept
    mustSupport: false
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'}
    isSummary: true
    index: 12
  accident:
    isModifier: false
    short: Details of the event
    type: BackboneElement
    mustSupport: false
    isSummary: false
    index: 81
    elements:
      date: {isModifier: false, short: When the incident occurred, type: date, mustSupport: false, isSummary: false, index: 82}
      type:
        isModifier: false
        short: The nature of the accident
        type: CodeableConcept
        mustSupport: false
        binding: {strength: extensible, valueSet: 'http://terminology.hl7.org/ValueSet/v3-ActIncidentCode'}
        isSummary: false
        index: 83
      location:
        isModifier: false
        short: Where the event occurred
        mustSupport: false
        choices: [locationAddress, locationReference]
        isSummary: false
        index: 85
      locationAddress: {isModifier: false, short: Where the event occurred, type: Address, mustSupport: false, choiceOf: location, isSummary: false, index: 86}
      locationReference:
        isModifier: false
        short: Where the event occurred
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        mustSupport: false
        choiceOf: location
        isSummary: false
        index: 87
    required: [date]
  status:
    isModifier: true
    short: active | cancelled | draft | entered-in-error
    index: 2
    type: code
    mustSupport: false
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status|5.0.0-draft-final'}
    isModifierReason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    isSummary: true
  payee:
    isModifier: false
    short: Recipient of benefits payable
    type: BackboneElement
    mustSupport: false
    isSummary: false
    index: 20
    elements:
      type:
        isModifier: false
        short: Category of recipient
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/payeetype'}
        isSummary: false
        index: 21
      party:
        isModifier: false
        short: Recipient reference
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Patient', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 22
    required: [type]
  prescription:
    isModifier: false
    short: Prescription authorizing services and products
    refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription']
    type: Reference
    mustSupport: false
    isSummary: false
    index: 18
  billablePeriod: {isModifier: false, short: Relevant time frame for the claim, type: Period, mustSupport: false, isSummary: true, index: 7}
  identifier: {isModifier: false, short: Business Identifier for claim, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 0}
  subType:
    isModifier: false
    short: More granular claim type
    type: CodeableConcept
    mustSupport: false
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-subtype'}
    isSummary: false
    index: 4
  provider:
    isModifier: false
    short: Party responsible for the claim
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 11
  patientPaid: {isModifier: false, short: Paid by the patient, type: Money, mustSupport: false, isSummary: false, index: 88}
  originalPrescription:
    isModifier: false
    short: Original prescription if superseded by fulfiller
    refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription']
    type: Reference
    mustSupport: false
    isSummary: false
    index: 19
  careTeam:
    isModifier: false
    short: Members of the care team
    index: 33
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequence: {isModifier: false, short: Order of care team, type: positiveInt, mustSupport: false, isSummary: false, index: 34}
      provider:
        isModifier: false
        short: Practitioner or organization
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 35
      responsible: {isModifier: false, short: Indicator of the lead practitioner, type: boolean, mustSupport: false, isSummary: false, index: 36}
      role:
        isModifier: false
        short: Function within the team
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-careteamrole'}
        isSummary: false
        index: 37
      specialty:
        isModifier: false
        short: Practitioner or provider specialization
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/provider-qualification'}
        isSummary: false
        index: 38
    required: [provider, sequence]
    isSummary: false
package_version: 5.0.0-draft-final
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/Claim
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: 5.0.0-draft-final
required: [created, status, type, patient, use]