Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED)
0.1.0 - ci-build
Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Draft as of 2024-11-04 |
Definitions for the MOPEDClaim resource profile.
Guidance on how to interpret the contents of this table can be found here
0. Claim | |
2. Claim.extension | |
Slicing | This element introduces a set of slices on Claim.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
4. Claim.extension:notiz | |
Slice Name | notiz |
Control | 0..* |
Type | Extension(Note) (Extension Type: Annotation) |
6. Claim.extension:diagnoseKnoten | |
Slice Name | diagnoseKnoten |
Control | 0..1 |
Type | Extension(Abrechnung - Knoten) (Extension Type: Coding) |
8. Claim.extension:lkfPunkte | |
Slice Name | lkfPunkte |
Control | 0..* |
Type | Extension(LKF Punkte) (Complex Extension) |
10. Claim.extension:fehlerWarnung | |
Slice Name | fehlerWarnung |
Control | 0..* |
Type | Extension(Error/Warning) (Complex Extension) |
12. Claim.extension:fondRelevant | |
Slice Name | fondRelevant |
Control | 0..1 |
Type | Extension(Fondsrelevanz) (Extension Type: Coding) |
14. Claim.extension:plausibilitaetskennzeichen | |
Slice Name | plausibilitaetskennzeichen |
Control | 0..1 |
Type | Extension(Plausibilitaetskennzeichen) (Extension Type: string) |
16. Claim.extension:svAbrechnungsquartal | |
Slice Name | svAbrechnungsquartal |
Control | 0..1 |
Type | Extension(Abrechnungsquartal der Sozialversicherung) (Complex Extension) |
18. Claim.patient | |
Type | Reference(HL7® AT Core Patient Profile) |
20. Claim.insurer | |
Control | 1..? |
Type | Reference(HL7® AT Core Organization Profile) |
22. Claim.provider | |
Control | 1..? |
Type | Reference(HL7® AT Core Organization Profile) |
24. Claim.related | |
26. Claim.related.claim | |
Type | Reference(MOPEDClaim) |
28. Claim.encounter | |
Control | 2..? |
Slicing | This element introduces a set of slices on Claim.encounter . The slices areUnordered and Open, and defines no disciminators to differentiate the slices |
30. Claim.encounter:MopedEncounter | |
Slice Name | MopedEncounter |
Short | Generelle Informationen zu Aufnahme und Entlassung des Patienten |
Control | 1..1 |
Type | Reference(MOPEDEncounter) |
32. Claim.encounter:TransferEncounter | |
Slice Name | TransferEncounter |
Short | Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten |
Control | 1..* |
Type | Reference(MOPEDTransferEncounter) |
34. Claim.diagnosisRelatedGroup | |
Short | "Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart. |
Binding | The codes SHALL be taken from http://tbd.at/MOPED-LKFAbrechnungsGruppe (required to http://tbd.at/MOPED-LKFAbrechnungsGruppe ) |
36. Claim.diagnosis | |
38. Claim.diagnosis.onAdmission | |
Definition | Gibt an ob die Diagnose bereits bei Aufnahme in den stationären Aufenthalt vorhanden war |
40. Claim.procedure | |
42. Claim.procedure.extension | |
Slicing | This element introduces a set of slices on Claim.procedure.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
44. Claim.procedure.extension:abrechnungsRelevanz | |
Slice Name | abrechnungsRelevanz |
Control | 0..1 |
Type | Extension(Medizinische Leistung - Abrechnungsrelevanz) (Extension Type: Coding) |
46. Claim.insurance | |
48. Claim.insurance.coverage | |
Type | Reference(SVCCoverage) |
Guidance on how to interpret the contents of this table can be found here
0. Claim | |
Definition | A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement. |
Short | Claim, Pre-determination or Pre-authorization |
Comments | The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services. |
Control | 0..* |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | Adjudication Request, Preauthorization Request, Predetermination Request |
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) |
2. Claim.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Short | A set of rules under which this content was created |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
4. Claim.contained | |
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning. |
Short | Contained, inline Resources |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. |
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5 |
Type | Resource |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | inline resources, anonymous resources, contained resources |
6. Claim.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on Claim.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
8. Claim.extension:notiz | |
Slice Name | notiz |
Definition | Additional notes that apply to this resource or element. |
Short | A recorded sex or gender property for the individual |
Comments | This extension SHALL NOT be used if the resource already has standard 'note' element (or equivalent) of type Annotation on the same element |
Control | 0..* |
Type | Extension(Note) (Extension Type: Annotation) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
10. Claim.extension:diagnoseKnoten | |
Slice Name | diagnoseKnoten |
Definition | "Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. |
Short | "Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. |
Control | 0..1 |
Type | Extension(Abrechnung - Knoten) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
12. Claim.extension:lkfPunkte | |
Slice Name | lkfPunkte |
Definition | In dieser Extension werden alle möglichen Punkteangaben im LKF zusammengefasst. |
Short | LKF Punkte |
Control | 0..* |
Type | Extension(LKF Punkte) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
14. Claim.extension:fehlerWarnung | |
Slice Name | fehlerWarnung |
Definition | MOPED Extension für akzeptierte Errors und Warnings |
Short | Error/Warning |
Control | 0..* |
Type | Extension(Error/Warning) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
16. Claim.extension:fondRelevant | |
Slice Name | fondRelevant |
Definition | Hier ist anzugeben, ob der stationäre Aufenthalt/ambulante Besuch gegenüber dem Landesgesundheitsfonds/PRIKRAF abzurechnen ist. |
Short | Fondsrelevanz |
Control | 0..1 |
Type | Extension(Fondsrelevanz) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
18. Claim.extension:plausibilitaetskennzeichen | |
Slice Name | plausibilitaetskennzeichen |
Definition | Dieses Datenfeld enthält eine Kennzeichnung als Ergebnis der vom Gesundheitsministerium vorgegebenen Plausibilitätsprüfung. |
Short | Plausibilitaetskennzeichen |
Control | 0..1 |
Type | Extension(Plausibilitaetskennzeichen) (Extension Type: string) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
20. Claim.extension:svAbrechnungsquartal | |
Slice Name | svAbrechnungsquartal |
Definition | Das Abrechnungsquartal ist in der Form Jahr (JJJJ) und Quartal (Q) zu melden. |
Short | Abrechnungsquartal der Sozialversicherung |
Control | 0..1 |
Type | Extension(Abrechnungsquartal der Sozialversicherung) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
22. Claim.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
Must Support | false |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
24. Claim.status | |
Definition | The status of the resource instance. |
Short | active | cancelled | draft | entered-in-error |
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
Control | 1..1 |
Binding | The codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|5.0.0 (required to http://hl7.org/fhir/ValueSet/fm-status|5.0.0 )A code specifying the state of the resource instance. |
Type | code |
Is Modifier | true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
26. Claim.type | |
Definition | The category of claim, e.g. oral, pharmacy, vision, institutional, professional. |
Short | Category or discipline |
Comments | The code system provides oral, pharmacy, vision, professional and institutional claim types. Those supported depends on the requirements of the jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction. |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type (extensible to http://hl7.org/fhir/ValueSet/claim-type )The type or discipline-style of the claim. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Claim type determine the general sets of business rules applied for information requirements and adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
28. Claim.use | |
Definition | A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided. |
Short | claim | preauthorization | predetermination |
Control | 1..1 |
Binding | The codes SHALL be taken from Usehttp://hl7.org/fhir/ValueSet/claim-use|5.0.0 (required to http://hl7.org/fhir/ValueSet/claim-use|5.0.0 )The purpose of the Claim: predetermination, preauthorization, claim. |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | This element is required to understand the nature of the request for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
30. Claim.patient | |
Definition | The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought. |
Short | The recipient of the products and services |
Control | 1..1 |
Type | Reference(HL7® AT Core Patient Profile, Patient) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
32. Claim.created | |
Definition | The date this resource was created. |
Short | Resource creation date |
Comments | This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. |
Control | 1..1 |
Type | dateTime |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Need to record a timestamp for use by both the recipient and the issuer. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
34. Claim.insurer | |
Definition | The Insurer who is target of the request. |
Short | Target |
Control | 10..1 |
Type | Reference(HL7® AT Core Organization Profile, Organization) |
Is Modifier | false |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
36. Claim.provider | |
Definition | The provider which is responsible for the claim, predetermination or preauthorization. |
Short | Party responsible for the claim |
Comments | Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner. |
Control | 10..1 |
Type | Reference(HL7® AT Core Organization Profile, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
38. Claim.encounter | |
Definition | Healthcare encounters related to this claim. |
Short | Encounters associated with the listed treatments |
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. |
Control | 20..* |
Type | Reference(Encounter) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Used in some jurisdictions to link clinical events to claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on Claim.encounter . The slices areUnordered and Open, and defines no disciminators to differentiate the slices |
40. Claim.encounter:MopedEncounter | |
Slice Name | MopedEncounter |
Definition | Healthcare encounters related to this claim. |
Short | Generelle Informationen zu Aufnahme und Entlassung des PatientenEncounters associated with the listed treatments |
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. |
Control | 10..1* |
Type | Reference(MOPEDEncounter, Encounter) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Used in some jurisdictions to link clinical events to claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
42. Claim.encounter:TransferEncounter | |
Slice Name | TransferEncounter |
Definition | Healthcare encounters related to this claim. |
Short | Informationen zu Verlegungen innerhalb oder zwischen KrankenanstaltenEncounters associated with the listed treatments |
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. |
Control | 10..* |
Type | Reference(MOPEDTransferEncounter, Encounter) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Used in some jurisdictions to link clinical events to claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
44. Claim.diagnosisRelatedGroup | |
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. |
Short | "Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart.Package billing code |
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. |
Control | 0..1 |
Binding | The codes SHALL be taken from For example codes, see http://tbd.at/MOPED-LKFAbrechnungsGruppehttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup (required to http://tbd.at/MOPED-LKFAbrechnungsGruppe ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Guidance on how to interpret the contents of this table can be found here
0. Claim | |
Definition | A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement. |
Short | Claim, Pre-determination or Pre-authorization |
Comments | The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services. |
Control | 0..* |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | Adjudication Request, Preauthorization Request, Predetermination Request |
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty() )dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource ( contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty() )dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated ( contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() )dom-5: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty() )dom-6: A resource should have narrative for robust management ( text.`div`.exists() ) |
2. Claim.id | |
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. |
Short | Logical id of this artifact |
Comments | Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case. |
Control | 0..1 |
Type | id |
Is Modifier | false |
Must Support | false |
Summary | true |
4. Claim.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. |
Short | Metadata about the resource |
Control | 0..1 |
Type | Meta |
Is Modifier | false |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
6. Claim.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Short | A set of rules under which this content was created |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
8. Claim.language | |
Definition | The base language in which the resource is written. |
Short | Language of the resource content |
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). |
Control | 0..1 |
Binding | The codes SHALL be taken from AllLanguages (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0 )IETF language tag for a human language |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
10. Claim.text | |
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. |
Short | Text summary of the resource, for human interpretation |
Comments | Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. |
Control | 0..1 This element is affected by the following invariants: dom-6 |
Type | Narrative |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | narrative, html, xhtml, display |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
12. Claim.contained | |
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning. |
Short | Contained, inline Resources |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. |
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5 |
Type | Resource |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | inline resources, anonymous resources, contained resources |
14. Claim.extension | |
Definition | An Extension |
Short | Extension |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
Slicing | This element introduces a set of slices on Claim.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
16. Claim.extension:notiz | |
Slice Name | notiz |
Definition | Additional notes that apply to this resource or element. |
Short | A recorded sex or gender property for the individual |
Comments | This extension SHALL NOT be used if the resource already has standard 'note' element (or equivalent) of type Annotation on the same element |
Control | 0..* |
Type | Extension(Note) (Extension Type: Annotation) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
18. Claim.extension:diagnoseKnoten | |
Slice Name | diagnoseKnoten |
Definition | "Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. |
Short | "Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. |
Control | 0..1 |
Type | Extension(Abrechnung - Knoten) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
20. Claim.extension:lkfPunkte | |
Slice Name | lkfPunkte |
Definition | In dieser Extension werden alle möglichen Punkteangaben im LKF zusammengefasst. |
Short | LKF Punkte |
Control | 0..* |
Type | Extension(LKF Punkte) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
22. Claim.extension:fehlerWarnung | |
Slice Name | fehlerWarnung |
Definition | MOPED Extension für akzeptierte Errors und Warnings |
Short | Error/Warning |
Control | 0..* |
Type | Extension(Error/Warning) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
24. Claim.extension:fondRelevant | |
Slice Name | fondRelevant |
Definition | Hier ist anzugeben, ob der stationäre Aufenthalt/ambulante Besuch gegenüber dem Landesgesundheitsfonds/PRIKRAF abzurechnen ist. |
Short | Fondsrelevanz |
Control | 0..1 |
Type | Extension(Fondsrelevanz) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
26. Claim.extension:plausibilitaetskennzeichen | |
Slice Name | plausibilitaetskennzeichen |
Definition | Dieses Datenfeld enthält eine Kennzeichnung als Ergebnis der vom Gesundheitsministerium vorgegebenen Plausibilitätsprüfung. |
Short | Plausibilitaetskennzeichen |
Control | 0..1 |
Type | Extension(Plausibilitaetskennzeichen) (Extension Type: string) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
28. Claim.extension:svAbrechnungsquartal | |
Slice Name | svAbrechnungsquartal |
Definition | Das Abrechnungsquartal ist in der Form Jahr (JJJJ) und Quartal (Q) zu melden. |
Short | Abrechnungsquartal der Sozialversicherung |
Control | 0..1 |
Type | Extension(Abrechnungsquartal der Sozialversicherung) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
30. Claim.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
Must Support | false |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
32. Claim.identifier | |
Definition | A unique identifier assigned to this claim. |
Short | Business Identifier for claim |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows claims to be distinguished and referenced. |
Alternate Names | Claim Number |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
34. Claim.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
36. Claim.status | |
Definition | The status of the resource instance. |
Short | active | cancelled | draft | entered-in-error |
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
Control | 1..1 |
Binding | The codes SHALL be taken from FinancialResourceStatusCodes (required to http://hl7.org/fhir/ValueSet/fm-status|5.0.0 )A code specifying the state of the resource instance. |
Type | code |
Is Modifier | true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
38. Claim.type | |
Definition | The category of claim, e.g. oral, pharmacy, vision, institutional, professional. |
Short | Category or discipline |
Comments | The code system provides oral, pharmacy, vision, professional and institutional claim types. Those supported depends on the requirements of the jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction. |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from ClaimTypeCodes (extensible to http://hl7.org/fhir/ValueSet/claim-type )The type or discipline-style of the claim. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Claim type determine the general sets of business rules applied for information requirements and adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
40. Claim.subType | |
Definition | A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. |
Short | More granular claim type |
Comments | This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. |
Control | 0..1 |
Binding | For example codes, see ExampleClaimSubTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-subtype )A more granular claim typecode. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Some jurisdictions need a finer grained claim type for routing and adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
42. Claim.use | |
Definition | A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided. |
Short | claim | preauthorization | predetermination |
Control | 1..1 |
Binding | The codes SHALL be taken from Use (required to http://hl7.org/fhir/ValueSet/claim-use|5.0.0 )The purpose of the Claim: predetermination, preauthorization, claim. |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | This element is required to understand the nature of the request for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
44. Claim.patient | |
Definition | The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought. |
Short | The recipient of the products and services |
Control | 1..1 |
Type | Reference(HL7® AT Core Patient Profile) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
46. Claim.billablePeriod | |
Definition | The period for which charges are being submitted. |
Short | Relevant time frame for the claim |
Comments | Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified. |
Control | 0..1 |
Type | Period |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
48. Claim.created | |
Definition | The date this resource was created. |
Short | Resource creation date |
Comments | This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. |
Control | 1..1 |
Type | dateTime |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Need to record a timestamp for use by both the recipient and the issuer. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
50. Claim.enterer | |
Definition | Individual who created the claim, predetermination or preauthorization. |
Short | Author of the claim |
Control | 0..1 |
Type | Reference(Practitioner, PractitionerRole, Patient, RelatedPerson) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Some jurisdictions require the contact information for personnel completing claims. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
52. Claim.insurer | |
Definition | The Insurer who is target of the request. |
Short | Target |
Control | 1..1 |
Type | Reference(HL7® AT Core Organization Profile) |
Is Modifier | false |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
54. Claim.provider | |
Definition | The provider which is responsible for the claim, predetermination or preauthorization. |
Short | Party responsible for the claim |
Comments | Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner. |
Control | 1..1 |
Type | Reference(HL7® AT Core Organization Profile) |
Is Modifier | false |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
56. Claim.priority | |
Definition | The provider-required urgency of processing the request. Typical values include: stat, normal, deferred. |
Short | Desired processing urgency |
Comments | If a claim processor is unable to complete the processing as per the priority then they should generate an error and not process the request. |
Control | 0..1 |
Binding | For example codes, see ProcessPriorityCodes (example to http://hl7.org/fhir/ValueSet/process-priority )The timeliness with which processing is required: stat, normal, deferred. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
58. Claim.fundsReserve | |
Definition | A code to indicate whether and for whom funds are to be reserved for future claims. |
Short | For whom to reserve funds |
Comments | This field is only used for preauthorizations. |
Control | 0..1 |
Binding | For example codes, see FundsReservationCodes (example to http://hl7.org/fhir/ValueSet/fundsreserve )For whom funds are to be reserved: (Patient, Provider, None). |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested. |
Alternate Names | Fund pre-allocation |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
60. Claim.related | |
Definition | Other claims which are related to this claim such as prior submissions or claims for related services or for the same event. |
Short | Prior or corollary claims |
Comments | For example, for the original treatment and follow-up exams. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | For workplace or other accidents it is common to relate separate claims arising from the same event. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
62. Claim.related.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
64. Claim.related.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
66. Claim.related.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
68. Claim.related.claim | |
Definition | Reference to a related claim. |
Short | Reference to the related claim |
Control | 0..1 |
Type | Reference(MOPEDClaim) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | For workplace or other accidents it is common to relate separate claims arising from the same event. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
70. Claim.related.relationship | |
Definition | A code to convey how the claims are related. |
Short | How the reference claim is related |
Comments | For example, prior claim or umbrella. |
Control | 0..1 |
Binding | For example codes, see ExampleRelatedClaimRelationshipCodes (example to http://hl7.org/fhir/ValueSet/related-claim-relationship )Relationship of this claim to a related Claim. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Some insurers need a declaration of the type of relationship. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
72. Claim.related.reference | |
Definition | An alternate organizational reference to the case or file to which this particular claim pertains. |
Short | File or case reference |
Comments | For example, Property/Casualty insurer claim # or Workers Compensation case # . |
Control | 0..1 |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
74. Claim.prescription | |
Definition | Prescription is the document/authorization given to the claim author for them to provide products and services for which consideration (reimbursement) is sought. Could be a RX for medications, an 'order' for oxygen or wheelchair or physiotherapy treatments. |
Short | Prescription authorizing services and products |
Control | 0..1 |
Type | Reference(DeviceRequest, MedicationRequest, VisionPrescription) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required to authorize the dispensing of controlled substances and devices. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
76. Claim.originalPrescription | |
Definition | Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. |
Short | Original prescription if superseded by fulfiller |
Comments | For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'. |
Control | 0..1 |
Type | Reference(DeviceRequest, MedicationRequest, VisionPrescription) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
78. Claim.payee | |
Definition | The party to be reimbursed for cost of the products and services according to the terms of the policy. |
Short | Recipient of benefits payable |
Comments | Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead. |
Control | 0..1 |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
80. Claim.payee.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
82. Claim.payee.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
84. Claim.payee.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
86. Claim.payee.type | |
Definition | Type of Party to be reimbursed: subscriber, provider, other. |
Short | Category of recipient |
Control | 1..1 |
Binding | For example codes, see ClaimPayeeTypeCodes (example to http://hl7.org/fhir/ValueSet/payeetype )A code for the party to be reimbursed. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
88. Claim.payee.party | |
Definition | Reference to the individual or organization to whom any payment will be made. |
Short | Recipient reference |
Comments | Not required if the payee is 'subscriber' or 'provider'. |
Control | 0..1 |
Type | Reference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Need to provide demographics if the payee is not 'subscriber' nor 'provider'. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
90. Claim.referral | |
Definition | The referral information received by the claim author, it is not to be used when the author generates a referral for a patient. A copy of that referral may be provided as supporting information. Some insurers require proof of referral to pay for services or to pay specialist rates for services. |
Short | Treatment referral |
Comments | The referral resource which lists the date, practitioner, reason and other supporting information. |
Control | 0..1 |
Type | Reference(ServiceRequest) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Some insurers require proof of referral to pay for services or to pay specialist rates for services. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
92. Claim.encounter | |
Definition | Healthcare encounters related to this claim. |
Short | Encounters associated with the listed treatments |
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. |
Control | 2..* |
Type | Reference(Encounter) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Used in some jurisdictions to link clinical events to claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
Slicing | This element introduces a set of slices on Claim.encounter . The slices areUnordered and Open, and defines no disciminators to differentiate the slices |
94. Claim.encounter:MopedEncounter | |
Slice Name | MopedEncounter |
Definition | Healthcare encounters related to this claim. |
Short | Generelle Informationen zu Aufnahme und Entlassung des Patienten |
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. |
Control | 1..1 |
Type | Reference(MOPEDEncounter) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Used in some jurisdictions to link clinical events to claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
96. Claim.encounter:TransferEncounter | |
Slice Name | TransferEncounter |
Definition | Healthcare encounters related to this claim. |
Short | Informationen zu Verlegungen innerhalb oder zwischen Krankenanstalten |
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. |
Control | 1..* |
Type | Reference(MOPEDTransferEncounter) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Used in some jurisdictions to link clinical events to claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
98. Claim.facility | |
Definition | Facility where the services were provided. |
Short | Servicing facility |
Control | 0..1 |
Type | Reference(Location, Organization) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Insurance adjudication can be dependant on where services were delivered. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
100. Claim.diagnosisRelatedGroup | |
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. |
Short | "Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart. |
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. |
Control | 0..1 |
Binding | The codes SHALL be taken from http://tbd.at/MOPED-LKFAbrechnungsGruppe (required to http://tbd.at/MOPED-LKFAbrechnungsGruppe ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
102. Claim.event | |
Definition | Information code for an event with a corresponding date or period. |
Short | Event information |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
104. Claim.event.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
106. Claim.event.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
108. Claim.event.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
110. Claim.event.type | |
Definition | A coded event such as when a service is expected or a card printed. |
Short | Specific event |
Control | 1..1 |
Binding | For example codes, see DatesTypeCodes (example to http://hl7.org/fhir/ValueSet/datestype ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
112. Claim.event.when[x] | |
Definition | A date or period in the past or future indicating when the event occurred or is expectd to occur. |
Short | Occurance date or period |
Control | 1..1 |
Type | Choice of: dateTime, Period |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
114. Claim.careTeam | |
Definition | The members of the team who provided the products and services. |
Short | Members of the care team |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Common to identify the responsible and supporting practitioners. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
116. Claim.careTeam.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
118. Claim.careTeam.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
120. Claim.careTeam.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
122. Claim.careTeam.sequence | |
Definition | A number to uniquely identify care team entries. |
Short | Order of care team |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
124. Claim.careTeam.provider | |
Definition | Member of the team who provided the product or service. |
Short | Practitioner or organization |
Control | 1..1 |
Type | Reference(Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Often a regulatory requirement to specify the responsible provider. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
126. Claim.careTeam.responsible | |
Definition | The party who is billing and/or responsible for the claimed products or services. |
Short | Indicator of the lead practitioner |
Comments | Responsible might not be required when there is only a single provider listed. |
Control | 0..1 |
Type | boolean |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | When multiple parties are present it is required to distinguish the lead or responsible individual. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
128. Claim.careTeam.role | |
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. |
Short | Function within the team |
Comments | Role might not be required when there is only a single provider listed. |
Control | 0..1 |
Binding | For example codes, see ClaimCareTeamRoleCodes (example to http://hl7.org/fhir/ValueSet/claim-careteamrole )The role codes for the care team members. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
130. Claim.careTeam.specialty | |
Definition | The specialization of the practitioner or provider which is applicable for this service. |
Short | Practitioner or provider specialization |
Control | 0..1 |
Binding | For example codes, see ExampleProviderQualificationCodes (example to http://hl7.org/fhir/ValueSet/provider-qualification ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Need to specify which specialization a practitioner or provider acting under when delivering the product or service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
132. Claim.supportingInfo | |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Short | Supporting information |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Alternate Names | Attachments Exception Codes Occurrence Codes Value codes |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
134. Claim.supportingInfo.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
136. Claim.supportingInfo.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
138. Claim.supportingInfo.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
140. Claim.supportingInfo.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Short | Information instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
142. Claim.supportingInfo.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Short | Classification of the supplied information |
Comments | This may contain a category for the local bill type codes. |
Control | 1..1 |
Binding | For example codes, see ClaimInformationCategoryCodes (example to http://hl7.org/fhir/ValueSet/claim-informationcategory )The valuset used for additional information category codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
144. Claim.supportingInfo.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Short | Type of information |
Control | 0..1 |
Binding | For example codes, see ExceptionCodes (example to http://hl7.org/fhir/ValueSet/claim-exception )The valuset used for additional information codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required to identify the kind of additional information. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
146. Claim.supportingInfo.timing[x] | |
Definition | The date when or period to which this information refers. |
Short | When it occurred |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
148. Claim.supportingInfo.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Short | Data to be provided |
Comments | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource), Identifier |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
150. Claim.supportingInfo.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Short | Explanation for the information |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Control | 0..1 |
Binding | For example codes, see MissingToothReasonCodes (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason )Reason codes for the missing teeth. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
152. Claim.diagnosis | |
Definition | Information about diagnoses relevant to the claim items. |
Short | Pertinent diagnosis information |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required for the adjudication by provided context for the services and product listed. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
154. Claim.diagnosis.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
156. Claim.diagnosis.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
158. Claim.diagnosis.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
160. Claim.diagnosis.sequence | |
Definition | A number to uniquely identify diagnosis entries. |
Short | Diagnosis instance identifier |
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
162. Claim.diagnosis.diagnosis[x] | |
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. |
Short | Nature of illness or problem |
Control | 1..1 |
Binding | For example codes, see ICD10Codes (example to http://hl7.org/fhir/ValueSet/icd-10 )Example ICD10 Diagnostic codes. |
Type | Choice of: CodeableConcept, Reference(Condition) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Provides health context for the evaluation of the products and/or services. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
164. Claim.diagnosis.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Timing or nature of the diagnosis |
Comments | For example: admitting, primary, secondary, discharge. |
Control | 0..* |
Binding | For example codes, see ExampleDiagnosisTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype )The type of the diagnosis: admitting, principal, discharge. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
166. Claim.diagnosis.onAdmission | |
Definition | Gibt an ob die Diagnose bereits bei Aufnahme in den stationären Aufenthalt vorhanden war |
Short | Present on admission |
Control | 0..1 |
Binding | For example codes, see ExampleDiagnosisOnAdmissionCodes (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission )Present on admission. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Many systems need to understand for adjudication if the diagnosis was present a time of admission. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
168. Claim.procedure | |
Definition | Procedures performed on the patient relevant to the billing items with the claim. |
Short | Clinical procedures performed |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
170. Claim.procedure.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
172. Claim.procedure.extension | |
Definition | An Extension |
Short | Extension |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
Slicing | This element introduces a set of slices on Claim.procedure.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
174. Claim.procedure.extension:abrechnungsRelevanz | |
Slice Name | abrechnungsRelevanz |
Definition | "Medizinische Leistung - Abrechnungsrelevanz:" Hier ist anzugeben, ob die medizinische Leistung bei der Bepunktung des ambulanten Besuchs/stationären Aufenthalts (Satzart X01) zu berücksichtigen ist. |
Short | Medizinische Leistung - Abrechnungsrelevanz |
Control | 0..1 |
Type | Extension(Medizinische Leistung - Abrechnungsrelevanz) (Extension Type: Coding) |
Is Modifier | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
176. Claim.procedure.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
178. Claim.procedure.sequence | |
Definition | A number to uniquely identify procedure entries. |
Short | Procedure instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to provide a mechanism to link to claim details. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
180. Claim.procedure.type | |
Definition | When the condition was observed or the relative ranking. |
Short | Category of Procedure |
Comments | For example: primary, secondary. |
Control | 0..* |
Binding | For example codes, see ExampleProcedureTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-procedure-type )Example procedure type codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
182. Claim.procedure.date | |
Definition | Date and optionally time the procedure was performed. |
Short | When the procedure was performed |
Control | 0..1 |
Type | dateTime |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Required for auditing purposes. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
184. Claim.procedure.procedure[x] | |
Definition | The code or reference to a Procedure resource which identifies the clinical intervention performed. |
Short | Specific clinical procedure |
Control | 1..1 |
Binding | For example codes, see ICD10ProcedureCodes (example to http://hl7.org/fhir/ValueSet/icd-10-procedures )Example ICD10 Procedure codes. |
Type | Choice of: CodeableConcept, Reference(Procedure) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | This identifies the actual clinical procedure. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
186. Claim.procedure.udi | |
Definition | Unique Device Identifiers associated with this line item. |
Short | Unique device identifier |
Control | 0..* |
Type | Reference(Device) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
188. Claim.insurance | |
Definition | Financial instruments for reimbursement for the health care products and services specified on the claim. |
Short | Patient insurance information |
Comments | All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | At least one insurer is required for a claim to be a claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
190. Claim.insurance.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
192. Claim.insurance.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
194. Claim.insurance.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
196. Claim.insurance.sequence | |
Definition | A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order. |
Short | Insurance instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | To maintain order of the coverages. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
198. Claim.insurance.focal | |
Definition | A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. |
Short | Coverage to be used for adjudication |
Comments | A 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. |
Control | 1..1 |
Type | boolean |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | To identify which coverage in the list is being used to adjudicate this claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
200. Claim.insurance.identifier | |
Definition | The business identifier to be used when the claim is sent for adjudication against this insurance policy. |
Short | Pre-assigned Claim number |
Comments | Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..1 |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
202. Claim.insurance.coverage | |
Definition | Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. |
Short | Insurance information |
Control | 1..1 |
Type | Reference(SVCCoverage) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Required to allow the adjudicator to locate the correct policy and history within their information system. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
204. Claim.insurance.businessArrangement | |
Definition | A business agreement number established between the provider and the insurer for special business processing purposes. |
Short | Additional provider contract number |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
206. Claim.insurance.preAuthRef | |
Definition | Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. |
Short | Prior authorization reference number |
Comments | This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. |
Control | 0..* |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
208. Claim.insurance.claimResponse | |
Definition | The result of the adjudication of the line items for the Coverage specified in this insurance. |
Short | Adjudication results |
Comments | Must not be specified when 'focal=true' for this insurance. |
Control | 0..1 |
Type | Reference(ClaimResponse) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
210. Claim.accident | |
Definition | Details of an accident which resulted in injuries which required the products and services listed in the claim. |
Short | Details of the event |
Control | 0..1 |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
212. Claim.accident.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
214. Claim.accident.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
216. Claim.accident.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
218. Claim.accident.date | |
Definition | Date of an accident event related to the products and services contained in the claim. |
Short | When the incident occurred |
Comments | The date of the accident has to precede the dates of the products and services but within a reasonable timeframe. |
Control | 1..1 |
Type | date |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Required for audit purposes and adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
220. Claim.accident.type | |
Definition | The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. |
Short | The nature of the accident |
Control | 0..1 |
Binding | Unless not suitable, these codes SHALL be taken from ActIncidentCode (extensible to http://terminology.hl7.org/ValueSet/v3-ActIncidentCode )Type of accident: work place, auto, etc. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Coverage may be dependant on the type of accident. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
222. Claim.accident.location[x] | |
Definition | The physical location of the accident event. |
Short | Where the event occurred |
Control | 0..1 |
Type | Choice of: Address, Reference(Location) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required for audit purposes and determination of applicable insurance liability. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
224. Claim.patientPaid | |
Definition | The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services. |
Short | Paid by the patient |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to demonstrate that copayments, co-insurance and similar patient payments have been made or accounted for. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
226. Claim.item | |
Definition | A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details. |
Short | Product or service provided |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The items to be processed for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
228. Claim.item.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
230. Claim.item.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
232. Claim.item.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
234. Claim.item.sequence | |
Definition | A number to uniquely identify item entries. |
Short | Item instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
236. Claim.item.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
238. Claim.item.careTeamSequence | |
Definition | CareTeam members related to this service or product. |
Short | Applicable careTeam members |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Need to identify the individuals and their roles in the provision of the product or service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
240. Claim.item.diagnosisSequence | |
Definition | Diagnosis applicable for this service or product. |
Short | Applicable diagnoses |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Need to related the product or service to the associated diagnoses. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
242. Claim.item.procedureSequence | |
Definition | Procedures applicable for this service or product. |
Short | Applicable procedures |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Need to provide any listed specific procedures to support the product or service being claimed. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
244. Claim.item.informationSequence | |
Definition | Exceptions, special conditions and supporting information applicable for this service or product. |
Short | Applicable exception and supporting information |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Need to reference the supporting information items that relate directly to this product or service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
246. Claim.item.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Short | Revenue or cost center code |
Control | 0..1 |
Binding | For example codes, see ExampleRevenueCenterCodes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center )Codes for the revenue or cost centers supplying the service and/or products. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed in the processing of institutional claims. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
248. Claim.item.category | |
Definition | Code to identify the general type of benefits under which products and services are provided. |
Short | Benefit classification |
Comments | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. |
Control | 0..1 |
Binding | For example codes, see BenefitCategoryCodes (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory )Benefit categories such as: oral-basic, major, glasses. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
250. Claim.item.productOrService | |
Definition | When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. |
Short | Billing, service, product, or drug code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls )Allowable service and product codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
252. Claim.item.productOrServiceEnd | |
Definition | This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims. |
Short | End of a range of codes |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | End of a range of Drug Code; Bill Code; Service Cod |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
254. Claim.item.request | |
Definition | Request or Referral for Goods or Service to be rendered. |
Short | Request or Referral for Service |
Control | 0..* |
Type | Reference(DeviceRequest, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | May identify the service to be provided or provider authorization for the service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
256. Claim.item.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Short | Product or service billing modifiers |
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. |
Control | 0..* |
Binding | For example codes, see ModifierTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-modifiers )Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
258. Claim.item.programCode | |
Definition | Identifies the program under which this may be recovered. |
Short | Program the product or service is provided under |
Comments | For example: Neonatal program, child dental program or drug users recovery program. |
Control | 0..* |
Binding | For example codes, see ExampleProgramReasonCodes (example to http://hl7.org/fhir/ValueSet/ex-program-code )Program specific reason codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
260. Claim.item.serviced[x] | |
Definition | The date or dates when the service or product was supplied, performed or completed. |
Short | Date or dates of service or product delivery |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Needed to determine whether the service or product was provided during the term of the insurance coverage. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
262. Claim.item.location[x] | |
Definition | Where the product or service was provided. |
Short | Place of service or where product was supplied |
Control | 0..1 |
Binding | For example codes, see ExampleServicePlaceCodes (example to http://hl7.org/fhir/ValueSet/service-place )Place of service: pharmacy, school, prison, etc. |
Type | Choice of: CodeableConcept, Address, Reference(Location) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
264. Claim.item.patientPaid | |
Definition | The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services. |
Short | Paid by the patient |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to demonstrate that copayments, co-insurance and similar patient payments have been made or accounted for. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
266. Claim.item.quantity | |
Definition | The number of repetitions of a service or product. |
Short | Count of products or services |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
268. Claim.item.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Short | Fee, charge or cost per item |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
270. Claim.item.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Short | Price scaling factor |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Control | 0..1 |
Type | decimal |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
272. Claim.item.tax | |
Definition | The total of taxes applicable for this product or service. |
Short | Total tax |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when taxes are not embedded in the unit price or provided as a separate service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
274. Claim.item.net | |
Definition | The total amount claimed for the group (if a grouper) or the line item. Net = unit price * quantity * factor. |
Short | Total item cost |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
276. Claim.item.udi | |
Definition | Unique Device Identifiers associated with this line item. |
Short | Unique device identifier |
Control | 0..* |
Type | Reference(Device) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
278. Claim.item.bodySite | |
Definition | Physical location where the service is performed or applies. |
Short | Anatomical location |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
280. Claim.item.bodySite.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
282. Claim.item.bodySite.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
284. Claim.item.bodySite.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
286. Claim.item.bodySite.site | |
Definition | Physical service site on the patient (limb, tooth, etc.). |
Short | Location |
Comments | For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed. |
Control | 1..* |
Binding | For example codes, see OralSiteCodes (example to http://hl7.org/fhir/ValueSet/tooth ) |
Type | CodeableReference(BodyStructure) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows insurer to validate specific procedures. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
288. Claim.item.bodySite.subSite | |
Definition | A region or surface of the bodySite, e.g. limb region or tooth surface(s). |
Short | Sub-location |
Control | 0..* |
Binding | For example codes, see SurfaceCodes (example to http://hl7.org/fhir/ValueSet/surface ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows insurer to validate specific procedures. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
290. Claim.item.encounter | |
Definition | Healthcare encounters related to this claim. |
Short | Encounters associated with the listed treatments |
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. |
Control | 0..* |
Type | Reference(Encounter) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Used in some jurisdictions to link clinical events to claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
292. Claim.item.detail | |
Definition | A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. |
Short | Product or service provided |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The items to be processed for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
294. Claim.item.detail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
296. Claim.item.detail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
298. Claim.item.detail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
300. Claim.item.detail.sequence | |
Definition | A number to uniquely identify item entries. |
Short | Item instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
302. Claim.item.detail.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
304. Claim.item.detail.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Short | Revenue or cost center code |
Control | 0..1 |
Binding | For example codes, see ExampleRevenueCenterCodes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center )Codes for the revenue or cost centers supplying the service and/or products. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed in the processing of institutional claims. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
306. Claim.item.detail.category | |
Definition | Code to identify the general type of benefits under which products and services are provided. |
Short | Benefit classification |
Comments | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. |
Control | 0..1 |
Binding | For example codes, see BenefitCategoryCodes (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory )Benefit categories such as: oral-basic, major, glasses. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
308. Claim.item.detail.productOrService | |
Definition | When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. |
Short | Billing, service, product, or drug code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls )Allowable service and product codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
310. Claim.item.detail.productOrServiceEnd | |
Definition | This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims. |
Short | End of a range of codes |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | End of a range of Drug Code; Bill Code; Service Cod |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
312. Claim.item.detail.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Short | Service/Product billing modifiers |
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
Control | 0..* |
Binding | For example codes, see ModifierTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-modifiers )Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
314. Claim.item.detail.programCode | |
Definition | Identifies the program under which this may be recovered. |
Short | Program the product or service is provided under |
Comments | For example: Neonatal program, child dental program or drug users recovery program. |
Control | 0..* |
Binding | For example codes, see ExampleProgramReasonCodes (example to http://hl7.org/fhir/ValueSet/ex-program-code )Program specific reason codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
316. Claim.item.detail.patientPaid | |
Definition | The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services. |
Short | Paid by the patient |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to demonstrate that copayments, co-insurance and similar patient payments have been made or accounted for. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
318. Claim.item.detail.quantity | |
Definition | The number of repetitions of a service or product. |
Short | Count of products or services |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
320. Claim.item.detail.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Short | Fee, charge or cost per item |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
322. Claim.item.detail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Short | Price scaling factor |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Control | 0..1 |
Type | decimal |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
324. Claim.item.detail.tax | |
Definition | The total of taxes applicable for this product or service. |
Short | Total tax |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when taxes are not embedded in the unit price or provided as a separate service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
326. Claim.item.detail.net | |
Definition | The total amount claimed for the group (if a grouper) or the line item.detail. Net = unit price * quantity * factor. |
Short | Total item cost |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
328. Claim.item.detail.udi | |
Definition | Unique Device Identifiers associated with this line item. |
Short | Unique device identifier |
Control | 0..* |
Type | Reference(Device) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
330. Claim.item.detail.subDetail | |
Definition | A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. |
Short | Product or service provided |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The items to be processed for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
332. Claim.item.detail.subDetail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
334. Claim.item.detail.subDetail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
336. Claim.item.detail.subDetail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
338. Claim.item.detail.subDetail.sequence | |
Definition | A number to uniquely identify item entries. |
Short | Item instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
340. Claim.item.detail.subDetail.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
342. Claim.item.detail.subDetail.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Short | Revenue or cost center code |
Control | 0..1 |
Binding | For example codes, see ExampleRevenueCenterCodes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center )Codes for the revenue or cost centers supplying the service and/or products. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed in the processing of institutional claims. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
344. Claim.item.detail.subDetail.category | |
Definition | Code to identify the general type of benefits under which products and services are provided. |
Short | Benefit classification |
Comments | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. |
Control | 0..1 |
Binding | For example codes, see BenefitCategoryCodes (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory )Benefit categories such as: oral-basic, major, glasses. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
346. Claim.item.detail.subDetail.productOrService | |
Definition | When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. |
Short | Billing, service, product, or drug code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls )Allowable service and product codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to state what was provided or done. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
348. Claim.item.detail.subDetail.productOrServiceEnd | |
Definition | This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims. |
Short | End of a range of codes |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | End of a range of Drug Code; Bill Code; Service Cod |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
350. Claim.item.detail.subDetail.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Short | Service/Product billing modifiers |
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
Control | 0..* |
Binding | For example codes, see ModifierTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-modifiers )Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
352. Claim.item.detail.subDetail.programCode | |
Definition | Identifies the program under which this may be recovered. |
Short | Program the product or service is provided under |
Comments | For example: Neonatal program, child dental program or drug users recovery program. |
Control | 0..* |
Binding | For example codes, see ExampleProgramReasonCodes (example to http://hl7.org/fhir/ValueSet/ex-program-code )Program specific reason codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
354. Claim.item.detail.subDetail.patientPaid | |
Definition | The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services. |
Short | Paid by the patient |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to demonstrate that copayments, co-insurance and similar patient payments have been made or accounted for. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
356. Claim.item.detail.subDetail.quantity | |
Definition | The number of repetitions of a service or product. |
Short | Count of products or services |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
358. Claim.item.detail.subDetail.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Short | Fee, charge or cost per item |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
360. Claim.item.detail.subDetail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Short | Price scaling factor |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Control | 0..1 |
Type | decimal |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
362. Claim.item.detail.subDetail.tax | |
Definition | The total of taxes applicable for this product or service. |
Short | Total tax |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when taxes are not embedded in the unit price or provided as a separate service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
364. Claim.item.detail.subDetail.net | |
Definition | The total amount claimed for line item.detail.subDetail. Net = unit price * quantity * factor. |
Short | Total item cost |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
366. Claim.item.detail.subDetail.udi | |
Definition | Unique Device Identifiers associated with this line item. |
Short | Unique device identifier |
Control | 0..* |
Type | Reference(Device) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
368. Claim.total | |
Definition | The total value of the all the items in the claim. |
Short | Total claim cost |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Used for control total purposes. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |