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

Resource Profile: MOPEDClaim - Detailed Descriptions

Draft as of 2024-11-12

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
SlicingThis element introduces a set of slices on Claim.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Claim.extension:notiz
    Slice Namenotiz
    Control0..*
    TypeExtension(Note) (Extension Type: Annotation)
    6. Claim.extension:diagnoseKnoten
    Slice NamediagnoseKnoten
    Control0..1
    TypeExtension(Abrechnung - Knoten) (Extension Type: Coding)
    8. Claim.extension:lkfPunkte
    Slice NamelkfPunkte
    Control0..*
    TypeExtension(LKF Punkte) (Complex Extension)
    10. Claim.extension:fehlerWarnung
    Slice NamefehlerWarnung
    Control0..*
    TypeExtension(Error/Warning) (Complex Extension)
    12. Claim.extension:fondRelevant
    Slice NamefondRelevant
    Control0..1
    TypeExtension(Fondsrelevanz) (Extension Type: Coding)
    14. Claim.extension:plausibilitaetskennzeichen
    Slice Nameplausibilitaetskennzeichen
    Control0..1
    TypeExtension(Plausibilitaetskennzeichen) (Extension Type: string)
    16. Claim.extension:svAbrechnungsquartal
    Slice NamesvAbrechnungsquartal
    Control0..1
    TypeExtension(Abrechnungsquartal der Sozialversicherung) (Complex Extension)
    18. Claim.patient
    TypeReference(HL7® AT Core Patient Profile)
    20. Claim.insurer
    Control1..?
    TypeReference(HL7® AT Core Organization Profile)
    22. Claim.provider
    Control1..?
    TypeReference(HL7® AT Core Organization Profile)
    24. Claim.related
    26. Claim.related.claim
    TypeReference(MOPEDClaim)
    28. Claim.encounter
    Control2..?
    SlicingThis element introduces a set of slices on Claim.encounter. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • profile @ resolve()
    • 30. Claim.encounter:MopedEncounter
      Slice NameMopedEncounter
      ShortGenerelle Informationen zu Aufnahme und Entlassung des Patienten
      Control1..1
      TypeReference(MOPEDEncounter)
      32. Claim.encounter:TransferEncounter
      Slice NameTransferEncounter
      ShortInformationen zu Verlegungen innerhalb oder zwischen Krankenanstalten
      Control1..*
      TypeReference(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.
      BindingThe 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
      SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 44. Claim.procedure.extension:abrechnungsRelevanz
        Slice NameabrechnungsRelevanz
        Control0..1
        TypeExtension(Medizinische Leistung - Abrechnungsrelevanz) (Extension Type: Coding)
        46. Claim.insurance
        48. Claim.insurance.coverage
        TypeReference(MOPEDCoverage)

        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.

        ShortClaim, 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.

        Control0..*
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
        Invariantsdom-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.

        ShortA 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.

        Control0..1
        Typeuri
        Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Invariantsele-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.

        ShortContained, 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.

        Control0..*
        This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
        TypeResource
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Alternate Namesinline 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.

        ShortExtensionAdditional 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.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-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())
        SlicingThis element introduces a set of slices on Claim.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 8. Claim.extension:notiz
          Slice Namenotiz
          Definition

          Additional notes that apply to this resource or element.

          ShortA 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

          Control0..*
          TypeExtension(Note) (Extension Type: Annotation)
          Is Modifierfalse
          Must Supportfalse
          Invariantsele-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 NamediagnoseKnoten
          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.
          Control0..1
          TypeExtension(Abrechnung - Knoten) (Extension Type: Coding)
          Is Modifierfalse
          Must Supportfalse
          Invariantsele-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 NamelkfPunkte
          Definition

          In dieser Extension werden alle möglichen Punkteangaben im LKF zusammengefasst.

          ShortLKF Punkte
          Control0..*
          TypeExtension(LKF Punkte) (Complex Extension)
          Is Modifierfalse
          Must Supportfalse
          Invariantsele-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 NamefehlerWarnung
          Definition

          MOPED Extension für akzeptierte Errors und Warnings

          ShortError/Warning
          Control0..*
          TypeExtension(Error/Warning) (Complex Extension)
          Is Modifierfalse
          Must Supportfalse
          Invariantsele-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 NamefondRelevant
          Definition

          Hier ist anzugeben, ob der stationäre Aufenthalt/ambulante Besuch gegenüber dem Landesgesundheitsfonds/PRIKRAF abzurechnen ist.

          ShortFondsrelevanz
          Control0..1
          TypeExtension(Fondsrelevanz) (Extension Type: Coding)
          Is Modifierfalse
          Must Supportfalse
          Invariantsele-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 Nameplausibilitaetskennzeichen
          Definition

          Dieses Datenfeld enthält eine Kennzeichnung als Ergebnis der vom Gesundheitsministerium vorgegebenen Plausibilitätsprüfung.

          ShortPlausibilitaetskennzeichen
          Control0..1
          TypeExtension(Plausibilitaetskennzeichen) (Extension Type: string)
          Is Modifierfalse
          Must Supportfalse
          Invariantsele-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 NamesvAbrechnungsquartal
          Definition

          Das Abrechnungsquartal ist in der Form Jahr (JJJJ) und Quartal (Q) zu melden.

          ShortAbrechnungsquartal der Sozialversicherung
          Control0..1
          TypeExtension(Abrechnungsquartal der Sozialversicherung) (Complex Extension)
          Is Modifierfalse
          Must Supportfalse
          Invariantsele-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).

          ShortExtensions 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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Must Supportfalse
          Summarytrue
          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 Namesextensions, user content
          Invariantsele-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.

          Shortactive | 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.

          Control1..1
          BindingThe 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.

          Typecode
          Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          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'.

          Invariantsele-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.

          ShortCategory 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.

          Control1..1
          BindingUnless 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.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          Claim type determine the general sets of business rules applied for information requirements and adjudication.

          Invariantsele-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.

          Shortclaim | preauthorization | predetermination
          Control1..1
          BindingThe 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.

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Requirements

          This element is required to understand the nature of the request for adjudication.

          Invariantsele-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.

          ShortThe recipient of the products and services
          Control1..1
          TypeReference(HL7® AT Core Patient Profile, Patient)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          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.

          Invariantsele-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.

          ShortResource 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.

          Control1..1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Requirements

          Need to record a timestamp for use by both the recipient and the issuer.

          Invariantsele-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.

          ShortTarget
          Control10..1
          TypeReference(HL7® AT Core Organization Profile, Organization)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-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.

          ShortParty 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.

          Control10..1
          TypeReference(HL7® AT Core Organization Profile, Practitioner, PractitionerRole, Organization)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-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.

          ShortEncounters 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.

          Control20..*
          TypeReference(Encounter)
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Requirements

          Used in some jurisdictions to link clinical events to claim items.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Claim.encounter. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • profile @ resolve()
          • 40. Claim.encounter:MopedEncounter
            Slice NameMopedEncounter
            Definition

            Healthcare encounters related to this claim.

            ShortGenerelle 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.

            Control10..1*
            TypeReference(MOPEDEncounter, Encounter)
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Requirements

            Used in some jurisdictions to link clinical events to claim items.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. Claim.encounter:TransferEncounter
            Slice NameTransferEncounter
            Definition

            Healthcare encounters related to this claim.

            ShortInformationen 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.

            Control10..*
            TypeReference(MOPEDTransferEncounter, Encounter)
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Requirements

            Used in some jurisdictions to link clinical events to claim items.

            Invariantsele-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.

            Control0..1
            BindingThe 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)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            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.

            Invariantsele-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.

            ShortClaim, 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.

            Control0..*
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
            Invariantsdom-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.

            ShortLogical 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.

            Control0..1
            Typeid
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            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.

            ShortMetadata about the resource
            Control0..1
            TypeMeta
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Invariantsele-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.

            ShortA 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.

            Control0..1
            Typeuri
            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            Summarytrue
            Invariantsele-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.

            ShortLanguage 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).

            Control0..1
            BindingThe 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

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            Summaryfalse
            Invariantsele-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.

            ShortText 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.

            Control0..1
            This element is affected by the following invariants: dom-6
            TypeNarrative
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Alternate Namesnarrative, html, xhtml, display
            Invariantsele-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.

            ShortContained, 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.

            Control0..*
            This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
            TypeResource
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Alternate Namesinline resources, anonymous resources, contained resources
            14. Claim.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-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())
            SlicingThis element introduces a set of slices on Claim.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 16. Claim.extension:notiz
              Slice Namenotiz
              Definition

              Additional notes that apply to this resource or element.

              ShortA 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

              Control0..*
              TypeExtension(Note) (Extension Type: Annotation)
              Is Modifierfalse
              Must Supportfalse
              Invariantsele-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 NamediagnoseKnoten
              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.
              Control0..1
              TypeExtension(Abrechnung - Knoten) (Extension Type: Coding)
              Is Modifierfalse
              Must Supportfalse
              Invariantsele-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 NamelkfPunkte
              Definition

              In dieser Extension werden alle möglichen Punkteangaben im LKF zusammengefasst.

              ShortLKF Punkte
              Control0..*
              TypeExtension(LKF Punkte) (Complex Extension)
              Is Modifierfalse
              Must Supportfalse
              Invariantsele-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 NamefehlerWarnung
              Definition

              MOPED Extension für akzeptierte Errors und Warnings

              ShortError/Warning
              Control0..*
              TypeExtension(Error/Warning) (Complex Extension)
              Is Modifierfalse
              Must Supportfalse
              Invariantsele-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 NamefondRelevant
              Definition

              Hier ist anzugeben, ob der stationäre Aufenthalt/ambulante Besuch gegenüber dem Landesgesundheitsfonds/PRIKRAF abzurechnen ist.

              ShortFondsrelevanz
              Control0..1
              TypeExtension(Fondsrelevanz) (Extension Type: Coding)
              Is Modifierfalse
              Must Supportfalse
              Invariantsele-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 Nameplausibilitaetskennzeichen
              Definition

              Dieses Datenfeld enthält eine Kennzeichnung als Ergebnis der vom Gesundheitsministerium vorgegebenen Plausibilitätsprüfung.

              ShortPlausibilitaetskennzeichen
              Control0..1
              TypeExtension(Plausibilitaetskennzeichen) (Extension Type: string)
              Is Modifierfalse
              Must Supportfalse
              Invariantsele-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 NamesvAbrechnungsquartal
              Definition

              Das Abrechnungsquartal ist in der Form Jahr (JJJJ) und Quartal (Q) zu melden.

              ShortAbrechnungsquartal der Sozialversicherung
              Control0..1
              TypeExtension(Abrechnungsquartal der Sozialversicherung) (Complex Extension)
              Is Modifierfalse
              Must Supportfalse
              Invariantsele-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).

              ShortExtensions 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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
              Must Supportfalse
              Summarytrue
              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 Namesextensions, user content
              Invariantsele-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.

              ShortBusiness Identifier for claim
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..*
              TypeIdentifier
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Allows claims to be distinguished and referenced.

              Alternate NamesClaim Number
              Invariantsele-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.

              ShortNumber for tracking
              Control0..*
              TypeIdentifier
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Allows partners to uniquely identify components for tracking.

              Invariantsele-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.

              Shortactive | 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.

              Control1..1
              BindingThe 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.

              Typecode
              Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summarytrue
              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'.

              Invariantsele-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.

              ShortCategory 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.

              Control1..1
              BindingUnless 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.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Requirements

              Claim type determine the general sets of business rules applied for information requirements and adjudication.

              Invariantsele-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.

              ShortMore 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.

              Control0..1
              BindingFor example codes, see ExampleClaimSubTypeCodes
              (example to http://hl7.org/fhir/ValueSet/claim-subtype)

              A more granular claim typecode.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Some jurisdictions need a finer grained claim type for routing and adjudication.

              Invariantsele-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.

              Shortclaim | preauthorization | predetermination
              Control1..1
              BindingThe 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.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summarytrue
              Requirements

              This element is required to understand the nature of the request for adjudication.

              Invariantsele-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.

              ShortThe recipient of the products and services
              Control1..1
              TypeReference(HL7® AT Core Patient Profile)
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              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.

              Invariantsele-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.

              ShortRelevant 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.

              Control0..1
              TypePeriod
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Requirements

              A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

              Invariantsele-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.

              ShortResource 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.

              Control1..1
              TypedateTime
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summarytrue
              Requirements

              Need to record a timestamp for use by both the recipient and the issuer.

              Invariantsele-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.

              ShortAuthor of the claim
              Control0..1
              TypeReference(Practitioner, PractitionerRole, Patient, RelatedPerson)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Some jurisdictions require the contact information for personnel completing claims.

              Invariantsele-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.

              ShortTarget
              Control1..1
              TypeReference(HL7® AT Core Organization Profile)
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Invariantsele-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.

              ShortParty 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.

              Control1..1
              TypeReference(HL7® AT Core Organization Profile)
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Invariantsele-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.

              ShortDesired 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.

              Control0..1
              BindingFor example codes, see ProcessPriorityCodes
              (example to http://hl7.org/fhir/ValueSet/process-priority)

              The timeliness with which processing is required: stat, normal, deferred.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Requirements

              The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

              Invariantsele-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.

              ShortFor whom to reserve funds
              Comments

              This field is only used for preauthorizations.

              Control0..1
              BindingFor example codes, see FundsReservationCodes
              (example to http://hl7.org/fhir/ValueSet/fundsreserve)

              For whom funds are to be reserved: (Patient, Provider, None).

              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              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 NamesFund pre-allocation
              Invariantsele-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.

              ShortPrior or corollary claims
              Comments

              For example, for the original treatment and follow-up exams.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              For workplace or other accidents it is common to relate separate claims arising from the same event.

              Invariantsele-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.

              ShortUnique id for inter-element referencing
              Control0..1
              This element is affected by the following invariants: ele-1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              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.

              ShortAdditional 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.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-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).

              ShortExtensions 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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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 Namesextensions, user content, modifiers
              Invariantsele-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.

              ShortReference to the related claim
              Control0..1
              TypeReference(MOPEDClaim)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              For workplace or other accidents it is common to relate separate claims arising from the same event.

              Invariantsele-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.

              ShortHow the reference claim is related
              Comments

              For example, prior claim or umbrella.

              Control0..1
              BindingFor example codes, see ExampleRelatedClaimRelationshipCodes
              (example to http://hl7.org/fhir/ValueSet/related-claim-relationship)

              Relationship of this claim to a related Claim.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Some insurers need a declaration of the type of relationship.

              Invariantsele-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.

              ShortFile or case reference
              Comments

              For example, Property/Casualty insurer claim # or Workers Compensation case # .

              Control0..1
              TypeIdentifier
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              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.

              Invariantsele-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.

              ShortPrescription authorizing services and products
              Control0..1
              TypeReference(DeviceRequest, MedicationRequest, VisionPrescription)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Required to authorize the dispensing of controlled substances and devices.

              Invariantsele-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.

              ShortOriginal 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'.

              Control0..1
              TypeReference(DeviceRequest, MedicationRequest, VisionPrescription)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.

              Invariantsele-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.

              ShortRecipient 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.

              Control0..1
              TypeBackboneElement
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

              Invariantsele-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.

              ShortUnique id for inter-element referencing
              Control0..1
              This element is affected by the following invariants: ele-1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              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.

              ShortAdditional 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.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-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).

              ShortExtensions 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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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 Namesextensions, user content, modifiers
              Invariantsele-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.

              ShortCategory of recipient
              Control1..1
              BindingFor example codes, see ClaimPayeeTypeCodes
              (example to http://hl7.org/fhir/ValueSet/payeetype)

              A code for the party to be reimbursed.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

              Invariantsele-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.

              ShortRecipient reference
              Comments

              Not required if the payee is 'subscriber' or 'provider'.

              Control0..1
              TypeReference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

              Invariantsele-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.

              ShortTreatment referral
              Comments

              The referral resource which lists the date, practitioner, reason and other supporting information.

              Control0..1
              TypeReference(ServiceRequest)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Some insurers require proof of referral to pay for services or to pay specialist rates for services.

              Invariantsele-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.

              ShortEncounters 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.

              Control2..*
              TypeReference(Encounter)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Used in some jurisdictions to link clinical events to claim items.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Claim.encounter. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • profile @ resolve()
              • 94. Claim.encounter:MopedEncounter
                Slice NameMopedEncounter
                Definition

                Healthcare encounters related to this claim.

                ShortGenerelle 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.

                Control1..1
                TypeReference(MOPEDEncounter)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Used in some jurisdictions to link clinical events to claim items.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                96. Claim.encounter:TransferEncounter
                Slice NameTransferEncounter
                Definition

                Healthcare encounters related to this claim.

                ShortInformationen 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.

                Control1..*
                TypeReference(MOPEDTransferEncounter)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Used in some jurisdictions to link clinical events to claim items.

                Invariantsele-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.

                ShortServicing facility
                Control0..1
                TypeReference(Location, Organization)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Insurance adjudication can be dependant on where services were delivered.

                Invariantsele-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.

                Control0..1
                BindingThe codes SHALL be taken from http://tbd.at/MOPED-LKFAbrechnungsGruppe
                (required to http://tbd.at/MOPED-LKFAbrechnungsGruppe)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                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.

                Invariantsele-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.

                ShortEvent information
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Invariantsele-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.

                ShortUnique id for inter-element referencing
                Control0..1
                This element is affected by the following invariants: ele-1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                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.

                ShortAdditional 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.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-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).

                ShortExtensions 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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                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 Namesextensions, user content, modifiers
                Invariantsele-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.

                ShortSpecific event
                Control1..1
                BindingFor example codes, see DatesTypeCodes
                (example to http://hl7.org/fhir/ValueSet/datestype)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Invariantsele-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.

                ShortOccurance date or period
                Control1..1
                TypeChoice of: dateTime, Period
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Invariantsele-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.

                ShortMembers of the care team
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Common to identify the responsible and supporting practitioners.

                Invariantsele-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.

                ShortUnique id for inter-element referencing
                Control0..1
                This element is affected by the following invariants: ele-1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                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.

                ShortAdditional 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.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-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).

                ShortExtensions 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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                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 Namesextensions, user content, modifiers
                Invariantsele-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.

                ShortOrder of care team
                Control1..1
                TypepositiveInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Requirements

                Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

                Invariantsele-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.

                ShortPractitioner or organization
                Control1..1
                TypeReference(Practitioner, PractitionerRole, Organization)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Often a regulatory requirement to specify the responsible provider.

                Invariantsele-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.

                ShortIndicator of the lead practitioner
                Comments

                Responsible might not be required when there is only a single provider listed.

                Control0..1
                Typeboolean
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Requirements

                When multiple parties are present it is required to distinguish the lead or responsible individual.

                Invariantsele-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.

                ShortFunction within the team
                Comments

                Role might not be required when there is only a single provider listed.

                Control0..1
                BindingFor example codes, see ClaimCareTeamRoleCodes
                (example to http://hl7.org/fhir/ValueSet/claim-careteamrole)

                The role codes for the care team members.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                When multiple parties are present it is required to distinguish the roles performed by each member.

                Invariantsele-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.

                ShortPractitioner or provider specialization
                Control0..1
                BindingFor example codes, see ExampleProviderQualificationCodes
                (example to http://hl7.org/fhir/ValueSet/provider-qualification)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Need to specify which specialization a practitioner or provider acting under when delivering the product or service.

                Invariantsele-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.

                ShortSupporting information
                Comments

                Often there are multiple jurisdiction specific valuesets which are required.

                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
                Invariantsele-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.

                ShortUnique id for inter-element referencing
                Control0..1
                This element is affected by the following invariants: ele-1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                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.

                ShortAdditional 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.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-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).

                ShortExtensions 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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                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 Namesextensions, user content, modifiers
                Invariantsele-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.

                ShortInformation instance identifier
                Control1..1
                TypepositiveInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Requirements

                Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                Invariantsele-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.

                ShortClassification of the supplied information
                Comments

                This may contain a category for the local bill type codes.

                Control1..1
                BindingFor example codes, see ClaimInformationCategoryCodes
                (example to http://hl7.org/fhir/ValueSet/claim-informationcategory)

                The valuset used for additional information category codes.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                Invariantsele-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.

                ShortType of information
                Control0..1
                BindingFor example codes, see ExceptionCodes
                (example to http://hl7.org/fhir/ValueSet/claim-exception)

                The valuset used for additional information codes.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Required to identify the kind of additional information.

                Invariantsele-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.

                ShortWhen it occurred
                Control0..1
                TypeChoice of: date, Period
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Invariantsele-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.

                ShortData 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.

                Control0..1
                TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource), Identifier
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Requirements

                To convey the data content to be provided when the information is more than a simple code or period.

                Invariantsele-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.

                ShortExplanation for the information
                Comments

                For example: the reason for the additional stay, or why a tooth is missing.

                Control0..1
                BindingFor example codes, see MissingToothReasonCodes
                (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                Reason codes for the missing teeth.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Needed when the supporting information has both a date and amount/value and requires explanation.

                Invariantsele-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.

                ShortPertinent diagnosis information
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Required for the adjudication by provided context for the services and product listed.

                Invariantsele-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.

                ShortUnique id for inter-element referencing
                Control0..1
                This element is affected by the following invariants: ele-1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                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.

                ShortAdditional 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.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-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).

                ShortExtensions 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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                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 Namesextensions, user content, modifiers
                Invariantsele-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.

                ShortDiagnosis instance identifier
                Comments

                Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                Control1..1
                TypepositiveInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Requirements

                Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                Invariantsele-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.

                ShortNature of illness or problem
                Control1..1
                BindingFor example codes, see ICD10Codes
                (example to http://hl7.org/fhir/ValueSet/icd-10)

                Example ICD10 Diagnostic codes.

                TypeChoice of: CodeableConcept, Reference(Condition)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Provides health context for the evaluation of the products and/or services.

                Invariantsele-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.

                ShortTiming or nature of the diagnosis
                Comments

                For example: admitting, primary, secondary, discharge.

                Control0..*
                BindingFor example codes, see ExampleDiagnosisTypeCodes
                (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                The type of the diagnosis: admitting, principal, discharge.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Often required to capture a particular diagnosis, for example: primary or discharge.

                Invariantsele-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

                ShortPresent on admission
                Control0..1
                BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                Present on admission.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                Invariantsele-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.

                ShortClinical procedures performed
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Requirements

                The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                Invariantsele-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.

                ShortUnique id for inter-element referencing
                Control0..1
                This element is affected by the following invariants: ele-1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                172. Claim.procedure.extension
                Definition

                An Extension

                ShortExtension
                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Invariantsele-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())
                SlicingThis element introduces a set of slices on Claim.procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 174. Claim.procedure.extension:abrechnungsRelevanz
                  Slice NameabrechnungsRelevanz
                  Definition

                  "Medizinische Leistung - Abrechnungsrelevanz:" Hier ist anzugeben, ob die medizinische Leistung bei der Bepunktung des ambulanten Besuchs/stationären Aufenthalts (Satzart X01) zu berücksichtigen ist.

                  ShortMedizinische Leistung - Abrechnungsrelevanz
                  Control0..1
                  TypeExtension(Medizinische Leistung - Abrechnungsrelevanz) (Extension Type: Coding)
                  Is Modifierfalse
                  Invariantsele-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).

                  ShortExtensions 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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  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 Namesextensions, user content, modifiers
                  Invariantsele-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.

                  ShortProcedure instance identifier
                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to provide a mechanism to link to claim details.

                  Invariantsele-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.

                  ShortCategory of Procedure
                  Comments

                  For example: primary, secondary.

                  Control0..*
                  BindingFor example codes, see ExampleProcedureTypeCodes
                  (example to http://hl7.org/fhir/ValueSet/ex-procedure-type)

                  Example procedure type codes.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Often required to capture a particular diagnosis, for example: primary or discharge.

                  Invariantsele-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.

                  ShortWhen the procedure was performed
                  Control0..1
                  TypedateTime
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Required for auditing purposes.

                  Invariantsele-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.

                  ShortSpecific clinical procedure
                  Control1..1
                  BindingFor example codes, see ICD10ProcedureCodes
                  (example to http://hl7.org/fhir/ValueSet/icd-10-procedures)

                  Example ICD10 Procedure codes.

                  TypeChoice of: CodeableConcept, Reference(Procedure)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  This identifies the actual clinical procedure.

                  Invariantsele-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.

                  ShortUnique device identifier
                  Control0..*
                  TypeReference(Device)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The UDI code allows the insurer to obtain device level information on the product supplied.

                  Invariantsele-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.

                  ShortPatient 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.

                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supportfalse
                  Summarytrue
                  Requirements

                  At least one insurer is required for a claim to be a claim.

                  Invariantsele-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.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  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.

                  ShortAdditional 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.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-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).

                  ShortExtensions 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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  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 Namesextensions, user content, modifiers
                  Invariantsele-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.

                  ShortInsurance instance identifier
                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summarytrue
                  Requirements

                  To maintain order of the coverages.

                  Invariantsele-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.

                  ShortCoverage 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.

                  Control1..1
                  Typeboolean
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summarytrue
                  Requirements

                  To identify which coverage in the list is being used to adjudicate this claim.

                  Invariantsele-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.

                  ShortPre-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'.

                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..1
                  TypeIdentifier
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  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.

                  Invariantsele-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.

                  ShortInsurance information
                  Control1..1
                  TypeReference(MOPEDCoverage)
                  Is Modifierfalse
                  Must Supportfalse
                  Summarytrue
                  Requirements

                  Required to allow the adjudicator to locate the correct policy and history within their information system.

                  Invariantsele-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.

                  ShortAdditional provider contract number
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.

                  Invariantsele-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.

                  ShortPrior 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.

                  Control0..*
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

                  Invariantsele-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.

                  ShortAdjudication results
                  Comments

                  Must not be specified when 'focal=true' for this insurance.

                  Control0..1
                  TypeReference(ClaimResponse)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  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.

                  Invariantsele-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.

                  ShortDetails of the event
                  Control0..1
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  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.

                  Invariantsele-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.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  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.

                  ShortAdditional 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.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-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).

                  ShortExtensions 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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  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 Namesextensions, user content, modifiers
                  Invariantsele-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.

                  ShortWhen the incident occurred
                  Comments

                  The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.

                  Control1..1
                  Typedate
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Required for audit purposes and adjudication.

                  Invariantsele-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.

                  ShortThe nature of the accident
                  Control0..1
                  BindingUnless 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.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Coverage may be dependant on the type of accident.

                  Invariantsele-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.

                  ShortWhere the event occurred
                  Control0..1
                  TypeChoice of: Address, Reference(Location)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Required for audit purposes and determination of applicable insurance liability.

                  Invariantsele-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.

                  ShortPaid by the patient
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to demonstrate that copayments, co-insurance and similar patient payments have been made or accounted for.

                  Invariantsele-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.

                  ShortProduct or service provided
                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The items to be processed for adjudication.

                  Invariantsele-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.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  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.

                  ShortAdditional 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.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-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).

                  ShortExtensions 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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  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 Namesextensions, user content, modifiers
                  Invariantsele-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.

                  ShortItem instance identifier
                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                  Invariantsele-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.

                  ShortNumber for tracking
                  Control0..*
                  TypeIdentifier
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Allows partners to uniquely identify components for tracking.

                  Invariantsele-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.

                  ShortApplicable careTeam members
                  Control0..*
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Need to identify the individuals and their roles in the provision of the product or service.

                  Invariantsele-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.

                  ShortApplicable diagnoses
                  Control0..*
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Need to related the product or service to the associated diagnoses.

                  Invariantsele-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.

                  ShortApplicable procedures
                  Control0..*
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Need to provide any listed specific procedures to support the product or service being claimed.

                  Invariantsele-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.

                  ShortApplicable exception and supporting information
                  Control0..*
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Need to reference the supporting information items that relate directly to this product or service.

                  Invariantsele-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.

                  ShortRevenue or cost center code
                  Control0..1
                  BindingFor 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.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Needed in the processing of institutional claims.

                  Invariantsele-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.

                  ShortBenefit classification
                  Comments

                  Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                  Control0..1
                  BindingFor example codes, see BenefitCategoryCodes
                  (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                  Benefit categories such as: oral-basic, major, glasses.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  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.

                  Invariantsele-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.

                  ShortBilling, 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'.

                  Control0..1
                  BindingFor example codes, see USCLSCodes
                  (example to http://hl7.org/fhir/ValueSet/service-uscls)

                  Allowable service and product codes.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to state what was provided or done.

                  Alternate NamesDrug Code, Bill Code, Service Code
                  Invariantsele-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.

                  ShortEnd of a range of codes
                  Control0..1
                  BindingFor example codes, see USCLSCodes
                  (example to http://hl7.org/fhir/ValueSet/service-uscls)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Alternate NamesEnd of a range of Drug Code; Bill Code; Service Cod
                  Invariantsele-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.

                  ShortRequest or Referral for Service
                  Control0..*
                  TypeReference(DeviceRequest, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  May identify the service to be provided or provider authorization for the service.

                  Invariantsele-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.

                  ShortProduct 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.

                  Control0..*
                  BindingFor 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.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  To support inclusion of the item for adjudication or to charge an elevated fee.

                  Invariantsele-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.

                  ShortProgram the product or service is provided under
                  Comments

                  For example: Neonatal program, child dental program or drug users recovery program.

                  Control0..*
                  BindingFor example codes, see ExampleProgramReasonCodes
                  (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                  Program specific reason codes.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                  Invariantsele-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.

                  ShortDate or dates of service or product delivery
                  Control0..1
                  TypeChoice of: date, Period
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Needed to determine whether the service or product was provided during the term of the insurance coverage.

                  Invariantsele-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.

                  ShortPlace of service or where product was supplied
                  Control0..1
                  BindingFor example codes, see ExampleServicePlaceCodes
                  (example to http://hl7.org/fhir/ValueSet/service-place)

                  Place of service: pharmacy, school, prison, etc.

                  TypeChoice of: CodeableConcept, Address, Reference(Location)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                  Invariantsele-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.

                  ShortPaid by the patient
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to demonstrate that copayments, co-insurance and similar patient payments have been made or accounted for.

                  Invariantsele-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.

                  ShortCount of products or services
                  Control0..1
                  TypeQuantity(SimpleQuantity)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Required when the product or service code does not convey the quantity provided.

                  Invariantsele-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.

                  ShortFee, charge or cost per item
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The amount charged to the patient by the provider for a single unit.

                  Invariantsele-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.

                  ShortPrice scaling factor
                  Comments

                  To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                  Control0..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                  Invariantsele-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.

                  ShortTotal tax
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Required when taxes are not embedded in the unit price or provided as a separate service.

                  Invariantsele-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.

                  ShortTotal item cost
                  Comments

                  For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Provides the total amount claimed for the group (if a grouper) or the line item.

                  Invariantsele-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.

                  ShortUnique device identifier
                  Control0..*
                  TypeReference(Device)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The UDI code allows the insurer to obtain device level information on the product supplied.

                  Invariantsele-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.

                  ShortAnatomical location
                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Invariantsele-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.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  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.

                  ShortAdditional 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.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-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).

                  ShortExtensions 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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  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 Namesextensions, user content, modifiers
                  Invariantsele-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.).

                  ShortLocation
                  Comments

                  For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

                  Control1..*
                  BindingFor example codes, see OralSiteCodes
                  (example to http://hl7.org/fhir/ValueSet/tooth)
                  TypeCodeableReference(BodyStructure)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Allows insurer to validate specific procedures.

                  Invariantsele-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).

                  ShortSub-location
                  Control0..*
                  BindingFor example codes, see SurfaceCodes
                  (example to http://hl7.org/fhir/ValueSet/surface)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Allows insurer to validate specific procedures.

                  Invariantsele-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.

                  ShortEncounters 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.

                  Control0..*
                  TypeReference(Encounter)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Used in some jurisdictions to link clinical events to claim items.

                  Invariantsele-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.

                  ShortProduct or service provided
                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The items to be processed for adjudication.

                  Invariantsele-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.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  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.

                  ShortAdditional 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.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-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).

                  ShortExtensions 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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  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 Namesextensions, user content, modifiers
                  Invariantsele-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.

                  ShortItem instance identifier
                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                  Invariantsele-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.

                  ShortNumber for tracking
                  Control0..*
                  TypeIdentifier
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Allows partners to uniquely identify components for tracking.

                  Invariantsele-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.

                  ShortRevenue or cost center code
                  Control0..1
                  BindingFor 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.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Needed in the processing of institutional claims.

                  Invariantsele-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.

                  ShortBenefit classification
                  Comments

                  Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                  Control0..1
                  BindingFor example codes, see BenefitCategoryCodes
                  (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                  Benefit categories such as: oral-basic, major, glasses.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  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.

                  Invariantsele-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.

                  ShortBilling, 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'.

                  Control0..1
                  BindingFor example codes, see USCLSCodes
                  (example to http://hl7.org/fhir/ValueSet/service-uscls)

                  Allowable service and product codes.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to state what was provided or done.

                  Alternate NamesDrug Code, Bill Code, Service Code
                  Invariantsele-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.

                  ShortEnd of a range of codes
                  Control0..1
                  BindingFor example codes, see USCLSCodes
                  (example to http://hl7.org/fhir/ValueSet/service-uscls)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Alternate NamesEnd of a range of Drug Code; Bill Code; Service Cod
                  Invariantsele-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.

                  ShortService/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.

                  Control0..*
                  BindingFor 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.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  To support inclusion of the item for adjudication or to charge an elevated fee.

                  Invariantsele-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.

                  ShortProgram the product or service is provided under
                  Comments

                  For example: Neonatal program, child dental program or drug users recovery program.

                  Control0..*
                  BindingFor example codes, see ExampleProgramReasonCodes
                  (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                  Program specific reason codes.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                  Invariantsele-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.

                  ShortPaid by the patient
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to demonstrate that copayments, co-insurance and similar patient payments have been made or accounted for.

                  Invariantsele-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.

                  ShortCount of products or services
                  Control0..1
                  TypeQuantity(SimpleQuantity)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Required when the product or service code does not convey the quantity provided.

                  Invariantsele-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.

                  ShortFee, charge or cost per item
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The amount charged to the patient by the provider for a single unit.

                  Invariantsele-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.

                  ShortPrice scaling factor
                  Comments

                  To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                  Control0..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                  Invariantsele-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.

                  ShortTotal tax
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Required when taxes are not embedded in the unit price or provided as a separate service.

                  Invariantsele-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.

                  ShortTotal item cost
                  Comments

                  For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Provides the total amount claimed for the group (if a grouper) or the line item.

                  Invariantsele-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.

                  ShortUnique device identifier
                  Control0..*
                  TypeReference(Device)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The UDI code allows the insurer to obtain device level information on the product supplied.

                  Invariantsele-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.

                  ShortProduct or service provided
                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The items to be processed for adjudication.

                  Invariantsele-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.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  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.

                  ShortAdditional 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.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-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).

                  ShortExtensions 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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  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 Namesextensions, user content, modifiers
                  Invariantsele-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.

                  ShortItem instance identifier
                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                  Invariantsele-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.

                  ShortNumber for tracking
                  Control0..*
                  TypeIdentifier
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Allows partners to uniquely identify components for tracking.

                  Invariantsele-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.

                  ShortRevenue or cost center code
                  Control0..1
                  BindingFor 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.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Needed in the processing of institutional claims.

                  Invariantsele-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.

                  ShortBenefit classification
                  Comments

                  Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                  Control0..1
                  BindingFor example codes, see BenefitCategoryCodes
                  (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                  Benefit categories such as: oral-basic, major, glasses.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  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.

                  Invariantsele-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.

                  ShortBilling, 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'.

                  Control0..1
                  BindingFor example codes, see USCLSCodes
                  (example to http://hl7.org/fhir/ValueSet/service-uscls)

                  Allowable service and product codes.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to state what was provided or done.

                  Invariantsele-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.

                  ShortEnd of a range of codes
                  Control0..1
                  BindingFor example codes, see USCLSCodes
                  (example to http://hl7.org/fhir/ValueSet/service-uscls)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Alternate NamesEnd of a range of Drug Code; Bill Code; Service Cod
                  Invariantsele-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.

                  ShortService/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.

                  Control0..*
                  BindingFor 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.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  To support inclusion of the item for adjudication or to charge an elevated fee.

                  Invariantsele-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.

                  ShortProgram the product or service is provided under
                  Comments

                  For example: Neonatal program, child dental program or drug users recovery program.

                  Control0..*
                  BindingFor example codes, see ExampleProgramReasonCodes
                  (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                  Program specific reason codes.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                  Invariantsele-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.

                  ShortPaid by the patient
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Necessary to demonstrate that copayments, co-insurance and similar patient payments have been made or accounted for.

                  Invariantsele-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.

                  ShortCount of products or services
                  Control0..1
                  TypeQuantity(SimpleQuantity)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Required when the product or service code does not convey the quantity provided.

                  Invariantsele-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.

                  ShortFee, charge or cost per item
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The amount charged to the patient by the provider for a single unit.

                  Invariantsele-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.

                  ShortPrice scaling factor
                  Comments

                  To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                  Control0..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                  Invariantsele-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.

                  ShortTotal tax
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Required when taxes are not embedded in the unit price or provided as a separate service.

                  Invariantsele-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.

                  ShortTotal item cost
                  Comments

                  For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Provides the total amount claimed for the group (if a grouper) or the line item.

                  Invariantsele-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.

                  ShortUnique device identifier
                  Control0..*
                  TypeReference(Device)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  The UDI code allows the insurer to obtain device level information on the product supplied.

                  Invariantsele-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.

                  ShortTotal claim cost
                  Control0..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Requirements

                  Used for control total purposes.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))