description: Base StructureDefinition for Claim Resource package_name: hl7.fhir.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: 61 elements: sequence: {type: positiveInt, short: Service instance identifier, index: 62} focal: {type: boolean, short: Is the focal Coverage, index: 63} coverage: short: Insurance information refers: ['http://hl7.org/fhir/StructureDefinition/Coverage'] type: Reference index: 64 businessArrangement: {type: string, short: Business agreement, index: 65} preAuthRef: {type: string, short: Pre-Authorization/Determination Reference, array: true, index: 66} claimResponse: short: Adjudication results refers: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse'] type: Reference index: 67 required: [coverage, focal, sequence] facility: short: Servicing Facility refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference index: 25 diagnosis: type: BackboneElement short: Diagnosis array: true index: 46 elements: sequence: {type: positiveInt, short: Number to covey order of diagnosis, index: 47} diagnosis: short: Patient's diagnosis choices: [diagnosisCodeableConcept, diagnosisReference] index: 49 diagnosisCodeableConcept: {short: Patient's diagnosis, type: CodeableConcept, choiceOf: diagnosis, index: 50} diagnosisReference: short: Patient's diagnosis refers: ['http://hl7.org/fhir/StructureDefinition/Condition'] type: Reference choiceOf: diagnosis index: 51 type: {short: Type of Diagnosis, comments: 'Diagnosis are presented in list order to their expected importance: primary, secondary, etc.', type: CodeableConcept, array: true, index: 52} packageCode: {short: Package billing code, type: CodeableConcept, index: 53} required: [diagnosisReference, diagnosis, diagnosisCodeableConcept, sequence] employmentImpacted: {type: Period, short: Period unable to work, index: 75} 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: 77 elements: category: {type: CodeableConcept, short: Type of service or product, index: 84} service: {type: CodeableConcept, short: Billing Code, index: 85} locationAddress: {short: Place of service, type: Address, choiceOf: location, index: 95} diagnosisLinkId: {type: positiveInt, short: Applicable diagnoses, array: true, index: 80} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 86} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 83} locationCodeableConcept: {short: Place of service, type: CodeableConcept, choiceOf: location, index: 94} net: {type: Money, short: Total item cost, index: 100} serviced: short: Date or dates of Service choices: [servicedDate, servicedPeriod] index: 89 subSite: {type: CodeableConcept, short: Service Sub-location, array: true, index: 103} informationLinkId: {type: positiveInt, short: Applicable exception and supporting information, array: true, index: 82} procedureLinkId: {type: positiveInt, short: Applicable procedures, array: true, index: 81} locationReference: short: Place of service refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference choiceOf: location index: 96 udi: short: Unique Device Identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference array: true index: 101 programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 87} factor: {type: decimal, short: Price scaling factor, index: 99} servicedDate: {short: Date or dates of Service, type: date, choiceOf: serviced, index: 90} sequence: {type: positiveInt, short: Service instance, index: 78} bodySite: {type: CodeableConcept, short: Service Location, index: 102} prosthesis: type: BackboneElement short: Prosthetic details index: 128 elements: initial: {type: boolean, short: Is this the initial service, index: 129} priorDate: {type: date, short: Initial service Date, index: 130} priorMaterial: {short: Prosthetic Material, type: CodeableConcept, index: 131} quantity: {type: Quantity, short: Count of Products or Services, index: 97} location: short: Place of service choices: [locationCodeableConcept, locationAddress, locationReference] index: 93 careTeamLinkId: {type: positiveInt, short: Applicable careTeam members, array: true, index: 79} unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 98} servicedPeriod: {short: Date or dates of Service, type: Period, choiceOf: serviced, index: 91} detail: type: BackboneElement short: Additional items array: true index: 104 elements: category: {type: CodeableConcept, short: Type of service or product, index: 107} service: {type: CodeableConcept, short: Billing Code, index: 108} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 109} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 106} net: {type: Money, short: Total additional item cost, index: 114} udi: short: Unique Device Identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference array: true index: 115 programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 110} factor: {type: decimal, short: Price scaling factor, index: 113} sequence: {type: positiveInt, short: Service instance, index: 105} subDetail: type: BackboneElement short: Additional items array: true index: 116 elements: category: {type: CodeableConcept, short: Type of service or product, index: 119} service: {type: CodeableConcept, short: Billing Code, index: 120} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 121} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 118} net: {type: Money, short: Net additional item cost, index: 126} udi: short: Unique Device Identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference array: true index: 127 programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 122} factor: {type: decimal, short: Price scaling factor, index: 125} sequence: {type: positiveInt, short: Service instance, index: 117} quantity: {type: Quantity, short: Count of Products or Services, index: 123} unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 124} required: [sequence] quantity: {type: Quantity, short: Count of Products or Services, index: 111} unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 112} required: [sequence] required: [sequence] type: {short: Type or discipline, comments: Affects which fields and value sets are used., type: CodeableConcept, index: 2} created: {type: dateTime, short: Creation date, index: 7} procedure: type: BackboneElement short: Procedures performed array: true index: 54 elements: sequence: {type: positiveInt, short: Procedure sequence for reference, index: 55} date: {short: When the procedure was performed, comments: 'SB DateTime??', type: dateTime, index: 56} procedure: short: Patient's list of procedures performed choices: [procedureCodeableConcept, procedureReference] index: 58 procedureCodeableConcept: {short: Patient's list of procedures performed, type: CodeableConcept, choiceOf: procedure, index: 59} procedureReference: short: Patient's list of procedures performed refers: ['http://hl7.org/fhir/StructureDefinition/Procedure'] type: Reference choiceOf: procedure index: 60 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'] comments: Do we need a relationship code? 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: 132} insurer: type: Reference short: Target refers: ['http://hl7.org/fhir/StructureDefinition/Organization'] index: 9 fundsReserve: {type: CodeableConcept, short: Funds requested to be reserved, index: 13} priority: {type: CodeableConcept, short: Desired processing priority, index: 12} accident: type: BackboneElement short: Details about an accident index: 68 elements: date: type: date short: |- When the accident occurred see information codes see information codes index: 69 type: {short: The nature of the accident, type: CodeableConcept, index: 70} location: short: Accident Place choices: [locationAddress, locationReference] index: 72 locationAddress: {type: Address, short: Accident Place, choiceOf: location, index: 73} locationReference: short: Accident Place refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference choiceOf: location index: 74 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 refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription'] comments: Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence. 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: 76} information: short: Exceptions, special considerations, the condition, situation, prior or concurrent issues type: BackboneElement array: true index: 32 elements: category: {short: Category of information, comments: This may contain the local bill type codes such as the US UB-04 bill type code., type: CodeableConcept, index: 33} valueReference: short: Additional Data or supporting information refers: ['http://hl7.org/fhir/StructureDefinition/Resource'] type: Reference choiceOf: value index: 44 valueQuantity: {type: Quantity, short: Additional Data or supporting information, choiceOf: value, index: 42} timingPeriod: {type: Period, short: When it occurred, choiceOf: timing, index: 38} value: short: Additional Data or supporting information choices: [valueString, valueQuantity, valueAttachment, valueReference] index: 40 valueString: {type: string, short: Additional Data or supporting information, choiceOf: value, index: 41} reason: {type: CodeableConcept, short: Reason associated with the information, index: 45} timing: short: When it occurred choices: [timingDate, timingPeriod] index: 36 code: {short: Type of information, comments: This may contain the local bill type codes such as the US UB-04 bill type code., type: CodeableConcept, index: 34} timingDate: {type: date, short: When it occurred, choiceOf: timing, index: 37} valueAttachment: {type: Attachment, short: Additional Data or supporting information, choiceOf: value, index: 43} required: [category] subType: {short: Finer grained claim type information, comments: This may contain the local bill type codes such as the US UB-04 bill type code., 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 refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest'] comments: as above. 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: 1.8.0 class: resource kind: resource url: http://hl7.org/fhir/StructureDefinition/Claim base: http://hl7.org/fhir/StructureDefinition/DomainResource version: null