description: Base StructureDefinition for Claim Resource
package_name: hl7.fhir.r3.core
derivation: specialization
name: Claim
type: Claim
elements:
  patient:
    short: The subject of the Products and Services
    refers: ['http://hl7.org/fhir/StructureDefinition/Patient']
    type: Reference
    index: 5
  insurance:
    short: Insurance or medical plan
    type: BackboneElement
    array: true
    index: 62
    elements:
      sequence: {type: positiveInt, short: Service instance identifier, index: 63}
      focal: {type: boolean, short: Is the focal Coverage, index: 64}
      coverage:
        short: Insurance information
        refers: ['http://hl7.org/fhir/StructureDefinition/Coverage']
        type: Reference
        index: 65
      businessArrangement: {type: string, short: Business agreement, index: 66}
      preAuthRef: {type: string, short: Pre-Authorization/Determination Reference, array: true, index: 67}
      claimResponse:
        short: Adjudication results
        refers: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse']
        type: Reference
        index: 68
    required: [coverage, focal, sequence]
  facility:
    short: Servicing Facility
    refers: ['http://hl7.org/fhir/StructureDefinition/Location']
    type: Reference
    index: 25
  diagnosis:
    short: List of Diagnosis
    type: BackboneElement
    array: true
    index: 47
    elements:
      sequence: {type: positiveInt, short: Number to covey order of diagnosis, index: 48}
      diagnosis:
        short: Patient's diagnosis
        choices: [diagnosisCodeableConcept, diagnosisReference]
        index: 50
      diagnosisCodeableConcept: {short: Patient's diagnosis, type: CodeableConcept, choiceOf: diagnosis, index: 51}
      diagnosisReference:
        short: Patient's diagnosis
        refers: ['http://hl7.org/fhir/StructureDefinition/Condition']
        type: Reference
        choiceOf: diagnosis
        index: 52
      type: {short: Timing or nature of the diagnosis, type: CodeableConcept, array: true, index: 53}
      packageCode: {short: Package billing code, type: CodeableConcept, index: 54}
    required: [diagnosisReference, diagnosis, diagnosisCodeableConcept, sequence]
  employmentImpacted: {type: Period, short: Period unable to work, index: 76}
  enterer:
    short: Author
    refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner']
    type: Reference
    index: 8
  use: {short: complete | proposed | exploratory | other, type: code, index: 4}
  item:
    type: BackboneElement
    short: Goods and Services
    array: true
    index: 78
    elements:
      category: {type: CodeableConcept, short: Type of service or product, index: 85}
      service: {type: CodeableConcept, short: Billing Code, index: 86}
      locationAddress: {short: Place of service, type: Address, choiceOf: location, index: 96}
      diagnosisLinkId: {type: positiveInt, short: Applicable diagnoses, array: true, index: 81}
      modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 87}
      revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 84}
      encounter:
        short: Encounters related to this billed item
        refers: ['http://hl7.org/fhir/StructureDefinition/Encounter']
        type: Reference
        array: true
        index: 105
      locationCodeableConcept: {short: Place of service, type: CodeableConcept, choiceOf: location, index: 95}
      net: {type: Money, short: Total item cost, index: 101}
      serviced:
        short: Date or dates of Service
        choices: [servicedDate, servicedPeriod]
        index: 90
      subSite: {type: CodeableConcept, short: Service Sub-location, array: true, index: 104}
      informationLinkId: {type: positiveInt, short: Applicable exception and supporting information, array: true, index: 83}
      procedureLinkId: {type: positiveInt, short: Applicable procedures, array: true, index: 82}
      locationReference:
        short: Place of service
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        choiceOf: location
        index: 97
      udi:
        short: Unique Device Identifier
        refers: ['http://hl7.org/fhir/StructureDefinition/Device']
        type: Reference
        array: true
        index: 102
      programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 88}
      factor: {type: decimal, short: Price scaling factor, index: 100}
      servicedDate: {short: Date or dates of Service, type: date, choiceOf: serviced, index: 91}
      sequence: {type: positiveInt, short: Service instance, index: 79}
      bodySite: {type: CodeableConcept, short: Service Location, index: 103}
      quantity: {type: Quantity, short: Count of Products or Services, index: 98}
      location:
        short: Place of service
        choices: [locationCodeableConcept, locationAddress, locationReference]
        index: 94
      careTeamLinkId: {type: positiveInt, short: Applicable careTeam members, array: true, index: 80}
      unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 99}
      servicedPeriod: {short: Date or dates of Service, type: Period, choiceOf: serviced, index: 92}
      detail:
        type: BackboneElement
        short: Additional items
        array: true
        index: 106
        elements:
          category: {type: CodeableConcept, short: Type of service or product, index: 109}
          service: {type: CodeableConcept, short: Billing Code, index: 110}
          modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 111}
          revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 108}
          net: {type: Money, short: Total additional item cost, index: 116}
          udi:
            short: Unique Device Identifier
            refers: ['http://hl7.org/fhir/StructureDefinition/Device']
            type: Reference
            array: true
            index: 117
          programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 112}
          factor: {type: decimal, short: Price scaling factor, index: 115}
          sequence: {type: positiveInt, short: Service instance, index: 107}
          subDetail:
            type: BackboneElement
            short: Additional items
            array: true
            index: 118
            elements:
              category: {type: CodeableConcept, short: Type of service or product, index: 121}
              service: {type: CodeableConcept, short: Billing Code, index: 122}
              modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 123}
              revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 120}
              net: {type: Money, short: Net additional item cost, index: 128}
              udi:
                short: Unique Device Identifier
                refers: ['http://hl7.org/fhir/StructureDefinition/Device']
                type: Reference
                array: true
                index: 129
              programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 124}
              factor: {type: decimal, short: Price scaling factor, index: 127}
              sequence: {type: positiveInt, short: Service instance, index: 119}
              quantity: {type: Quantity, short: Count of Products or Services, index: 125}
              unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 126}
            required: [sequence]
          quantity: {type: Quantity, short: Count of Products or Services, index: 113}
          unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 114}
        required: [sequence]
    required: [sequence]
  type: {short: Type or discipline, type: CodeableConcept, index: 2}
  created: {type: dateTime, short: Creation date, index: 7}
  procedure:
    type: BackboneElement
    short: Procedures performed
    array: true
    index: 55
    elements:
      sequence: {type: positiveInt, short: Procedure sequence for reference, index: 56}
      date: {short: When the procedure was performed, type: dateTime, index: 57}
      procedure:
        short: Patient's list of procedures performed
        choices: [procedureCodeableConcept, procedureReference]
        index: 59
      procedureCodeableConcept: {short: Patient's list of procedures performed, type: CodeableConcept, choiceOf: procedure, index: 60}
      procedureReference:
        short: Patient's list of procedures performed
        refers: ['http://hl7.org/fhir/StructureDefinition/Procedure']
        type: Reference
        choiceOf: procedure
        index: 61
    required: [procedureReference, sequence, procedure, procedureCodeableConcept]
  related:
    type: BackboneElement
    short: Related Claims which may be revelant to processing this claimn
    array: true
    index: 14
    elements:
      claim:
        short: Reference to the related claim
        refers: ['http://hl7.org/fhir/StructureDefinition/Claim']
        type: Reference
        index: 15
      relationship: {type: CodeableConcept, short: How the reference claim is related, index: 16}
      reference: {type: Identifier, short: Related file or case reference, index: 17}
  organization:
    short: Responsible organization
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    index: 11
  referral:
    short: Treatment Referral
    refers: ['http://hl7.org/fhir/StructureDefinition/ReferralRequest']
    type: Reference
    index: 24
  total: {type: Money, short: Total claim cost, index: 130}
  insurer:
    short: Target
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    index: 9
  fundsReserve: {type: CodeableConcept, short: Funds requested to be reserved, index: 13}
  priority: {short: Desired processing priority, type: CodeableConcept, index: 12}
  accident:
    type: BackboneElement
    short: Details about an accident
    index: 69
    elements:
      date:
        type: date
        short: |-
          When the accident occurred
          see information codes
          see information codes
        index: 70
      type: {short: The nature of the accident, type: CodeableConcept, index: 71}
      location:
        short: Accident Place
        choices: [locationAddress, locationReference]
        index: 73
      locationAddress: {type: Address, short: Accident Place, choiceOf: location, index: 74}
      locationReference:
        short: Accident Place
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        choiceOf: location
        index: 75
    required: [date]
  status: {isModifier: true, short: active | cancelled | draft | entered-in-error, type: code, isSummary: true, index: 1}
  payee:
    type: BackboneElement
    short: Party to be paid any benefits payable
    index: 20
    elements:
      type: {type: CodeableConcept, short: 'Type of party: Subscriber, Provider, other', index: 21}
      resourceType: {type: Coding, short: organization | patient | practitioner | relatedperson, index: 22}
      party:
        type: Reference
        short: Party to receive the payable
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Patient', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson']
        index: 23
    required: [type]
  prescription:
    short: Prescription authorizing services or products
    refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription']
    type: Reference
    index: 18
  billablePeriod: {type: Period, short: Period for charge submission, index: 6}
  identifier: {type: Identifier, short: Claim number, array: true, index: 0}
  hospitalization: {type: Period, short: Period in hospital, index: 77}
  information:
    short: Exceptions, special considerations, the condition, situation, prior or concurrent issues
    type: BackboneElement
    array: true
    index: 32
    elements:
      category: {short: General class of information, type: CodeableConcept, index: 34}
      valueReference:
        short: Additional Data or supporting information
        refers: ['http://hl7.org/fhir/StructureDefinition/Resource']
        type: Reference
        choiceOf: value
        index: 45
      valueQuantity: {type: Quantity, short: Additional Data or supporting information, choiceOf: value, index: 43}
      timingPeriod: {type: Period, short: When it occurred, choiceOf: timing, index: 39}
      value:
        short: Additional Data or supporting information
        choices: [valueString, valueQuantity, valueAttachment, valueReference]
        index: 41
      valueString: {type: string, short: Additional Data or supporting information, choiceOf: value, index: 42}
      reason: {type: CodeableConcept, short: Reason associated with the information, index: 46}
      timing:
        short: When it occurred
        choices: [timingDate, timingPeriod]
        index: 37
      sequence: {type: positiveInt, short: Information instance identifier, index: 33}
      code: {short: Type of information, type: CodeableConcept, index: 35}
      timingDate: {type: date, short: When it occurred, choiceOf: timing, index: 38}
      valueAttachment: {type: Attachment, short: Additional Data or supporting information, choiceOf: value, index: 44}
    required: [sequence, category]
  subType: {short: Finer grained claim type information, type: CodeableConcept, array: true, index: 3}
  provider:
    short: Responsible provider
    refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner']
    type: Reference
    index: 10
  originalPrescription:
    short: Original prescription if superceded by fulfiller
    refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest']
    type: Reference
    index: 19
  careTeam:
    short: Members of the care team
    type: BackboneElement
    array: true
    index: 26
    elements:
      sequence: {type: positiveInt, short: Number to covey order of careTeam, index: 27}
      provider:
        short: Provider individual or organization
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner']
        type: Reference
        index: 28
      responsible: {type: boolean, short: Billing provider, index: 29}
      role: {type: CodeableConcept, short: Role on the team, index: 30}
      qualification: {type: CodeableConcept, short: 'Type, classification or Specialization', index: 31}
    required: [provider, sequence]
package_version: 3.0.2
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/Claim
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: null