description: Base StructureDefinition for Claim Resource
package_name: hl7.fhir.r2.core
name: Claim
type: null
elements:
  patient: {type: Reference, short: The subject of the Products and Services, isSummary: true, index: 25}
  originalRuleset: {short: Original specification followed, type: Coding, isSummary: true, index: 3}
  facility: {type: Reference, short: Servicing Facility, isSummary: true, index: 12}
  diagnosis:
    type: BackboneElement
    short: Diagnosis
    isSummary: true
    array: true
    index: 21
    elements:
      sequence: {type: positiveInt, short: Sequence of diagnosis, isSummary: true, index: 22}
      diagnosis: {short: Patient's list of diagnosis, type: Coding, isSummary: true, index: 23}
    required: [diagnosis, sequence]
  school: {type: string, short: Name of School, isSummary: true, index: 36}
  enterer: {type: Reference, short: Author, isSummary: true, index: 11}
  use: {type: code, short: complete | proposed | exploratory | other, isSummary: true, index: 8}
  item:
    type: BackboneElement
    short: Goods and Services
    isSummary: true
    array: true
    index: 40
    elements:
      service: {type: Coding, short: Item Code, isSummary: true, index: 45}
      diagnosisLinkId: {type: positiveInt, short: Diagnosis Link, isSummary: true, array: true, index: 44}
      modifier: {short: Service/Product billing modifiers, type: Coding, array: true, isSummary: true, index: 55}
      net: {type: Quantity, short: Total item cost, isSummary: true, index: 51}
      type: {type: Coding, short: Group or type of product or service, isSummary: true, index: 42}
      points: {type: decimal, short: Difficulty scaling factor, isSummary: true, index: 50}
      subSite: {type: Coding, short: Service Sub-location, isSummary: true, array: true, index: 54}
      serviceDate: {type: date, short: Date of Service, isSummary: true, index: 46}
      udi: {short: Unique Device Identifier, type: Coding, isSummary: true, index: 52}
      factor: {type: decimal, short: Price scaling factor, isSummary: true, index: 49}
      sequence: {type: positiveInt, short: Service instance, isSummary: true, index: 41}
      bodySite: {type: Coding, short: Service Location, isSummary: true, index: 53}
      prosthesis:
        type: BackboneElement
        short: Prosthetic details
        isSummary: true
        index: 76
        elements:
          initial: {type: boolean, short: Is this the initial service, isSummary: true, index: 77}
          priorDate: {type: date, short: Initial service Date, isSummary: true, index: 78}
          priorMaterial: {short: Prosthetic Material, type: Coding, isSummary: true, index: 79}
      quantity: {type: Quantity, short: Count of Products or Services, isSummary: true, index: 47}
      provider: {type: Reference, short: Responsible practitioner, isSummary: true, index: 43}
      unitPrice: {type: Quantity, short: 'Fee, charge or cost per point', isSummary: true, index: 48}
      detail:
        type: BackboneElement
        short: Additional items
        isSummary: true
        array: true
        index: 56
        elements:
          service: {type: Coding, short: Additional item codes, isSummary: true, index: 59}
          net: {type: Quantity, short: Total additional item cost, isSummary: true, index: 64}
          type: {type: Coding, short: Group or type of product or service, isSummary: true, index: 58}
          points: {type: decimal, short: Difficulty scaling factor, isSummary: true, index: 63}
          udi: {short: Unique Device Identifier, type: Coding, isSummary: true, index: 65}
          factor: {type: decimal, short: Price scaling factor, isSummary: true, index: 62}
          sequence: {type: positiveInt, short: Service instance, isSummary: true, index: 57}
          subDetail:
            type: BackboneElement
            short: Additional items
            isSummary: true
            array: true
            index: 66
            elements:
              service: {type: Coding, short: Additional item codes, isSummary: true, index: 69}
              net: {type: Quantity, short: Net additional item cost, isSummary: true, index: 74}
              type: {type: Coding, short: Type of product or service, isSummary: true, index: 68}
              points: {type: decimal, short: Difficulty scaling factor, isSummary: true, index: 73}
              udi: {short: Unique Device Identifier, type: Coding, isSummary: true, index: 75}
              factor: {type: decimal, short: Price scaling factor, isSummary: true, index: 72}
              sequence: {type: positiveInt, short: Service instance, isSummary: true, index: 67}
              quantity: {type: Quantity, short: Count of Products or Services, isSummary: true, index: 70}
              unitPrice: {type: Quantity, short: 'Fee, charge or cost per point', isSummary: true, index: 71}
            required: [sequence, type, service]
          quantity: {type: Quantity, short: Count of Products or Services, isSummary: true, index: 60}
          unitPrice: {type: Quantity, short: 'Fee, charge or cost per point', isSummary: true, index: 61}
        required: [sequence, type, service]
    required: [sequence, type, service]
  coverage:
    short: Insurance or medical plan
    type: BackboneElement
    array: true
    isSummary: true
    index: 26
    elements:
      sequence: {type: positiveInt, short: Service instance identifier, isSummary: true, index: 27}
      focal: {type: boolean, short: The focal Coverage, isSummary: true, index: 28}
      coverage: {type: Reference, short: Insurance information, isSummary: true, index: 29}
      businessArrangement: {type: string, short: Business agreement, isSummary: true, index: 30}
      relationship: {short: Patient relationship to subscriber, type: Coding, isSummary: true, index: 31}
      preAuthRef: {type: string, short: Pre-Authorization/Determination Reference, isSummary: true, array: true, index: 32}
      claimResponse: {type: Reference, short: Adjudication results, isSummary: true, index: 33}
      originalRuleset: {short: Original version, type: Coding, isSummary: true, index: 34}
    required: [coverage, focal, relationship, sequence]
  type: {short: institutional | oral | pharmacy | professional | vision, comments: Affects which fields and value sets are used., type: code, isSummary: true, index: 0}
  created: {type: dateTime, short: Creation date, isSummary: true, index: 4}
  organization: {type: Reference, short: Responsible organization, isSummary: true, index: 7}
  missingTeeth:
    short: Only if type = oral
    type: BackboneElement
    array: true
    isSummary: true
    index: 81
    elements:
      tooth: {short: Tooth Code, type: Coding, isSummary: true, index: 82}
      reason: {short: Reason for missing, type: Coding, isSummary: true, index: 83}
      extractionDate: {type: date, short: Date of Extraction, isSummary: true, index: 84}
    required: [tooth]
  referral: {type: Reference, short: Treatment Referral, isSummary: true, index: 20}
  fundsReserve: {type: Coding, short: Funds requested to be reserved, isSummary: true, index: 10}
  priority: {type: Coding, short: Desired processing priority, isSummary: true, index: 9}
  accident: {type: date, short: Accident Date, isSummary: true, index: 37}
  payee:
    type: BackboneElement
    short: Payee
    isSummary: true
    index: 15
    elements:
      type: {type: Coding, short: Party to be paid any benefits payable, isSummary: true, index: 16}
      provider: {type: Reference, short: Provider who is the payee, isSummary: true, index: 17}
      organization: {type: Reference, short: Organization who is the payee, isSummary: true, index: 18}
      person: {type: Reference, short: Other person who is the payee, isSummary: true, index: 19}
  prescription: {type: Reference, short: Prescription, isSummary: true, index: 13}
  condition: {type: Coding, short: List of presenting Conditions, isSummary: true, array: true, index: 24}
  identifier: {type: Identifier, short: Claim number, isSummary: true, array: true, index: 1}
  exception: {short: Eligibility exceptions, type: Coding, array: true, isSummary: true, index: 35}
  target: {type: Reference, short: Insurer, isSummary: true, index: 5}
  interventionException: {short: Intervention and exception code (Pharma), type: Coding, array: true, isSummary: true, index: 39}
  additionalMaterials: {type: Coding, short: 'Additional materials, documents, etc.', isSummary: true, array: true, index: 80}
  ruleset: {short: Current specification followed, type: Coding, isSummary: true, index: 2}
  provider: {type: Reference, short: Responsible provider, isSummary: true, index: 6}
  originalPrescription: {type: Reference, short: Original Prescription, isSummary: true, index: 14}
  accidentType: {short: Accident Type, type: Coding, isSummary: true, index: 38}
package_version: 1.0.2
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/Claim
version: null
required: [type, patient]