description: This profile sets minimum expectations for the providers and payors, insurers, to exchange the financial information, and supporting clinical information.
package_name: rs/ndhm.in
derivation: constraint
name: Claim
type: Claim
elements:
  patient:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient']
    index: 2
  insurance:
    mustSupport: true
    index: 42
    elements:
      coverage:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage']
        index: 43
      preAuthRef: {index: 44}
      claimResponse:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse']
        index: 45
    required: [preAuthRef]
  diagnosis:
    index: 29
    elements:
      diagnosis:
        choices: [diagnosisCodeableConcept, diagnosisReference]
        index: 31
      diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 32}
      diagnosisReference:
        type: Reference
        choiceOf: diagnosis
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition']
        index: 33
      type:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-diagnostic-type'}
        index: 34
        elements:
          coding:
            elements:
              system: {index: 35}
              code: {index: 36}
              display: {index: 37}
            required: [code, display, system]
    required: [type]
  enterer:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
    index: 3
  supportingInfo:
    mustSupport: true
    index: 20
    elements:
      category:
        binding: {strength: preferred, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-supportinginfo-category'}
        index: 21
        elements:
          coding:
            elements:
              system: {index: 22}
              code: {index: 23}
              display: {index: 24}
            required: [code, display, system]
      code:
        binding: {strength: preferred, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-supportinginfo-code'}
        index: 25
        elements:
          coding:
            elements:
              system: {index: 26}
              code: {index: 27}
              display: {index: 28}
            required: [code, display, system]
    required: [code]
  item:
    mustSupport: true
    index: 46
    elements:
      category:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-benefitcategory'}
        index: 47
        elements:
          coding:
            elements:
              system: {index: 48}
              code: {index: 49}
              display: {index: 50}
            required: [code, display, system]
      productOrService:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
        index: 51
        elements:
          coding:
            elements:
              system: {index: 52}
              code: {index: 53}
              display: {index: 54}
            required: [code, display, system]
      programCode:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-program-code'}
        index: 55
        elements:
          coding:
            elements:
              system: {index: 56}
              code: {index: 57}
              display: {index: 58}
            required: [code, display, system]
      encounter:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Encounter']
        index: 59
      detail:
        elements:
          category:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-benefitcategory'}
            index: 60
            elements:
              coding:
                elements:
                  system: {index: 61}
                  code: {index: 62}
                  display: {index: 63}
                required: [code, display, system]
          productOrService:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
            index: 64
            elements:
              coding:
                elements:
                  system: {index: 65}
                  code: {index: 66}
                  display: {index: 67}
                required: [code, display, system]
          programCode:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-program-code'}
            index: 68
            elements:
              coding:
                elements:
                  system: {index: 69}
                  code: {index: 70}
                  display: {index: 71}
                required: [code, display, system]
          subDetail:
            elements:
              category:
                binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-benefitcategory'}
                index: 72
                elements:
                  coding:
                    elements:
                      system: {index: 73}
                      code: {index: 74}
                      display: {index: 75}
                    required: [code, display, system]
              productOrService:
                binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
                index: 76
                elements:
                  coding:
                    elements:
                      system: {index: 77}
                      code: {index: 78}
                      display: {index: 79}
                    required: [code, display, system]
              programCode:
                binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-program-code'}
                index: 80
                elements:
                  coding:
                    elements:
                      system: {index: 81}
                      code: {index: 82}
                      display: {index: 83}
                    required: [code, display, system]
  type:
    binding: {strength: extensible, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-claim-type'}
    index: 1
  procedure:
    elements:
      procedure:
        choices: [procedureCodeableConcept, procedureReference]
        index: 39
      procedureCodeableConcept: {type: CodeableConcept, choiceOf: procedure, index: 40}
      procedureReference:
        type: Reference
        choiceOf: procedure
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Procedure']
        index: 41
  related:
    elements:
      claim:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim']
        index: 6
  referral:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/ServiceRequest']
    index: 10
  insurer:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
    index: 4
  payee:
    elements:
      party:
        type: Reference
        refers: ['http://hl7.org/fhir/StructureDefinition/RelatedPerson', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
        index: 9
  prescription:
    type: Reference
    refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/MedicationRequest']
    index: 7
  identifier: {mustSupport: true, index: 0}
  provider:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
    index: 5
  originalPrescription:
    type: Reference
    refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/MedicationRequest']
    index: 8
  careTeam:
    elements:
      provider:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
        index: 11
      role:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-care-team-role'}
        index: 12
        elements:
          coding:
            elements:
              system: {index: 13}
              code: {index: 14}
              display: {index: 15}
            required: [code, display, system]
      qualification:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-care-team-qualification'}
        index: 16
        elements:
          coding:
            elements:
              system: {index: 17}
              code: {index: 18}
              display: {index: 19}
            required: [code, display, system]
package_version: 4.0.0
class: profile
kind: resource
url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 4.0.0
required: [diagnosis, identifier, insurer, item]