{
  "description": null,
  "_filename": "DwClaim.StructureDefinition.json",
  "package_name": "telus.dw.emr.extract",
  "date": "2024-05-03T22:11:40.4165223+00:00",
  "derivation": "constraint",
  "publisher": null,
  "fhirVersion": "4.0.1",
  "name": "DwClaim",
  "abstract": false,
  "type": "Claim",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": null,
  "package_version": "1.0.0",
  "status": "draft",
  "id": "b08bbe17-5123-4134-9208-d92576358e86",
  "kind": "resource",
  "url": "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwClaim",
  "version": null,
  "differential": {
    "element": [ {
      "id": "Claim.id",
      "min": 1,
      "path": "Claim.id",
      "mustSupport": true
    }, {
      "id": "Claim.meta",
      "path": "Claim.meta"
    }, {
      "id": "Claim.meta.lastUpdated",
      "min": 1,
      "path": "Claim.meta.lastUpdated"
    }, {
      "id": "Claim.meta.source",
      "min": 1,
      "path": "Claim.meta.source"
    }, {
      "id": "Claim.text",
      "min": 1,
      "path": "Claim.text",
      "mustSupport": true
    }, {
      "id": "Claim.identifier",
      "path": "Claim.identifier",
      "mustSupport": true
    }, {
      "id": "Claim.status",
      "path": "Claim.status",
      "comment": "Usagae note: \r\nClaim submitted → active\r\nClaim not submitted → draft\r\nClaim deleted before submission→entered-in-error\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.",
      "mustSupport": true
    }, {
      "id": "Claim.type",
      "path": "Claim.type",
      "comment": "Usage note: \r\nInpatient, hospital bills --> Institutional \r\nOutpatient clinic bills --> professional\r\nThe majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.",
      "mustSupport": true
    }, {
      "id": "Claim.use",
      "path": "Claim.use",
      "comment": "Usage note: For submitted ministry billing use Claim\r\nNote that FHIR strings SHALL NOT exceed 1MB in size",
      "mustSupport": true
    }, {
      "id": "Claim.patient",
      "path": "Claim.patient",
      "mustSupport": true
    }, {
      "id": "Claim.created",
      "path": "Claim.created",
      "mustSupport": true
    }, {
      "id": "Claim.provider",
      "path": "Claim.provider",
      "mustSupport": true
    }, {
      "id": "Claim.priority",
      "path": "Claim.priority",
      "comment": "Usage note: Default to \"Normal\"\r\nIf a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.",
      "mustSupport": true
    }, {
      "id": "Claim.diagnosis",
      "path": "Claim.diagnosis",
      "comment": "Usage note: Diagnosis code for the whole bill",
      "mustSupport": true
    }, {
      "id": "Claim.insurance",
      "path": "Claim.insurance",
      "mustSupport": true
    }, {
      "id": "Claim.insurance.sequence",
      "path": "Claim.insurance.sequence",
      "comment": "Usage note: Sequence is always 1 \r\n32 bit number; for values larger than this, use decimal"
    }, {
      "id": "Claim.insurance.focal",
      "path": "Claim.insurance.focal",
      "comment": "Usage note: focal is always true\r\nA patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies."
    }, {
      "id": "Claim.insurance.coverage.display",
      "path": "Claim.insurance.coverage.display",
      "comment": "Usage note: Provide the coverage as display only. Display -   Province - Ministry Billing\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "mustSupport": true
    }, {
      "id": "Claim.item.sequence",
      "path": "Claim.item.sequence",
      "mustSupport": true
    }, {
      "id": "Claim.item.diagnosisSequence",
      "path": "Claim.item.diagnosisSequence",
      "mustSupport": true
    }, {
      "id": "Claim.item.productOrService",
      "path": "Claim.item.productOrService",
      "mustSupport": true
    }, {
      "id": "Claim.item.productOrService.extension:DataAbsentReason",
      "path": "Claim.item.productOrService.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/StructureDefinition/data-absent-reason" ]
      } ],
      "comment": "In some EMR's the claim can be created without a service code when in the draft state. These will be provided with a data absent reason of \"unknown\"",
      "sliceName": "DataAbsentReason",
      "isModifier": false
    }, {
      "id": "Claim.item.productOrService.text",
      "min": 1,
      "path": "Claim.item.productOrService.text",
      "mustSupport": true
    }, {
      "id": "Claim.item.serviced[x]",
      "path": "Claim.item.serviced[x]",
      "mustSupport": true
    }, {
      "id": "Claim.item.quantity",
      "path": "Claim.item.quantity",
      "comment": "Usage note: Typically documented as unit or calls in EMR \r\nThe context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.",
      "mustSupport": true
    }, {
      "id": "Claim.item.net",
      "path": "Claim.item.net",
      "mustSupport": true
    }, {
      "id": "Claim.item.encounter",
      "path": "Claim.item.encounter",
      "mustSupport": true
    }, {
      "id": "Claim.total",
      "path": "Claim.total",
      "mustSupport": true
    } ]
  },
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Claim"
}