Finance and Insurance Service (FAIS)
1.0.0 - trial-use
This page is part of the IHE ITI Finance and Insurance Services (v1.0.0: Publication) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
Official URL: https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim | Version: 1.0.0 | |||
Active as of 2024-11-13 | Computable Name: FAISClaim |
The FAIS Claim profile for submitting claims.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Claim
Name | Flags | Card. | Type | Description & Constraints![]() |
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Claim | |||
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0..0 | |||
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |
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0..1 | CodeableConcept | Request Status Reason URL: https://profiles.ihe.net/ITI/FAIS/StructureDefinition/request-statusReason | |
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0..0 | |||
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||||
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0..1 | Reference(FAIS Claim Profile) | Reference to the related claim | |
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Name | Flags | Card. | Type | Description & Constraints![]() |
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0..* | Claim | Claim, Pre-determination or Pre-authorization | |
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |
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0..1 | CodeableConcept | Request Status Reason URL: https://profiles.ihe.net/ITI/FAIS/StructureDefinition/request-statusReason | |
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?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
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Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
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Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. |
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Σ | 1..1 | Reference(Patient) | The recipient of the products and services |
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Σ | 1..1 | dateTime | Resource creation date |
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Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim |
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Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
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Σ | 1..* | BackboneElement | Patient insurance information |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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Σ | 1..1 | positiveInt | Insurance instance identifier |
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Σ | 1..1 | boolean | Coverage to be used for adjudication |
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Σ | 1..1 | Reference(Coverage) | Insurance information |
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Path | Conformance | ValueSet | URI |
Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | |
Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | |
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard |
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
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0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||
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Σ | 0..1 | id | Logical id of this artifact | ||||
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Σ | 0..1 | Meta | Metadata about the resource | ||||
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0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
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0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
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0..* | Resource | Contained, inline Resources | |||||
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0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
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0..1 | CodeableConcept | Request Status Reason URL: https://profiles.ihe.net/ITI/FAIS/StructureDefinition/request-statusReason | |||||
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0..* | Identifier | Business Identifier for claim | |||||
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?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
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Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
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0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |||||
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Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. | ||||
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Σ | 1..1 | Reference(Patient) | The recipient of the products and services | ||||
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Σ | 0..1 | Period | Relevant time frame for the claim | ||||
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Σ | 1..1 | dateTime | Resource creation date | ||||
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0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||
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Σ | 0..1 | Reference(Organization) | Target | ||||
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Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim | ||||
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Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
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0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
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0..* | BackboneElement | Prior or corollary claims | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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0..1 | Reference(FAIS Claim Profile) | Reference to the related claim | |||||
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0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||
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0..1 | Identifier | File or case reference | |||||
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0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||
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0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||
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0..1 | BackboneElement | Recipient of benefits payable | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
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0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
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0..1 | Reference(ServiceRequest) | Treatment referral | |||||
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0..1 | Reference(Location) | Servicing facility | |||||
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0..* | BackboneElement | Members of the care team | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | positiveInt | Order of care team | |||||
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1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
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0..1 | boolean | Indicator of the lead practitioner | |||||
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0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. | |||||
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0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |||||
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0..* | BackboneElement | Supporting information | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | positiveInt | Information instance identifier | |||||
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1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |||||
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0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
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0..1 | When it occurred | ||||||
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date | |||||||
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Period | |||||||
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0..1 | Data to be provided | ||||||
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boolean | |||||||
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string | |||||||
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Quantity | |||||||
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Attachment | |||||||
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Reference(Resource) | |||||||
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0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
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0..* | BackboneElement | Pertinent diagnosis information | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | positiveInt | Diagnosis instance identifier | |||||
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1..1 | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||||||
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CodeableConcept | |||||||
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Reference(Condition) | |||||||
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0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. | |||||
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0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||
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0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||
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0..* | BackboneElement | Clinical procedures performed | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | positiveInt | Procedure instance identifier | |||||
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0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||
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0..1 | dateTime | When the procedure was performed | |||||
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1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||||||
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CodeableConcept | |||||||
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Reference(Procedure) | |||||||
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0..* | Reference(Device) | Unique device identifier | |||||
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Σ | 1..* | BackboneElement | Patient insurance information | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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Σ | 1..1 | positiveInt | Insurance instance identifier | ||||
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Σ | 1..1 | boolean | Coverage to be used for adjudication | ||||
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0..1 | Identifier | Pre-assigned Claim number | |||||
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Σ | 1..1 | Reference(Coverage) | Insurance information | ||||
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0..1 | string | Additional provider contract number | |||||
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0..* | string | Prior authorization reference number | |||||
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0..1 | Reference(ClaimResponse) | Adjudication results | |||||
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0..1 | BackboneElement | Details of the event | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | date | When the incident occurred | |||||
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0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |||||
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0..1 | Where the event occurred | ||||||
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Address | |||||||
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Reference(Location) | |||||||
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0..* | BackboneElement | Product or service provided | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | positiveInt | Item instance identifier | |||||
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0..* | positiveInt | Applicable careTeam members | |||||
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0..* | positiveInt | Applicable diagnoses | |||||
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0..* | positiveInt | Applicable procedures | |||||
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0..* | positiveInt | Applicable exception and supporting information | |||||
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0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
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0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
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1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
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0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
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0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
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0..1 | Date or dates of service or product delivery | ||||||
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date | |||||||
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Period | |||||||
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0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
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CodeableConcept | |||||||
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Address | |||||||
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Reference(Location) | |||||||
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0..1 | SimpleQuantity | Count of products or services | |||||
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0..1 | Money | Fee, charge or cost per item | |||||
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0..1 | decimal | Price scaling factor | |||||
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0..1 | Money | Total item cost | |||||
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0..* | Reference(Device) | Unique device identifier | |||||
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0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
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0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
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0..* | Reference(Encounter) | Encounters related to this billed item | |||||
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0..* | BackboneElement | Product or service provided | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | positiveInt | Item instance identifier | |||||
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0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
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0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
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1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
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0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
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0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
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0..1 | SimpleQuantity | Count of products or services | |||||
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0..1 | Money | Fee, charge or cost per item | |||||
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0..1 | decimal | Price scaling factor | |||||
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0..1 | Money | Total item cost | |||||
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0..* | Reference(Device) | Unique device identifier | |||||
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0..* | BackboneElement | Product or service provided | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | positiveInt | Item instance identifier | |||||
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0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
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0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
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1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
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0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
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0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
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0..1 | SimpleQuantity | Count of products or services | |||||
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0..1 | Money | Fee, charge or cost per item | |||||
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0..1 | decimal | Price scaling factor | |||||
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0..1 | Money | Total item cost | |||||
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0..* | Reference(Device) | Unique device identifier | |||||
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0..1 | Money | Total claim cost | |||||
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Path | Conformance | ValueSet | URI | |||
Claim.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | ||||
Claim.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard | ||||
Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | ||||
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard | ||||
Claim.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard | ||||
Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationship from the FHIR Standard | ||||
Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard | ||||
Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole from the FHIR Standard | ||||
Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualification from the FHIR Standard | ||||
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory from the FHIR Standard | ||||
Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception from the FHIR Standard | ||||
Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reason from the FHIR Standard | ||||
Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard | ||||
Claim.diagnosis.type | example | ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype from the FHIR Standard | ||||
Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission from the FHIR Standard | ||||
Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup from the FHIR Standard | ||||
Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type from the FHIR Standard | ||||
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures from the FHIR Standard | ||||
Claim.accident.type | extensible | ActIncidentCodehttp://terminology.hl7.org/ValueSet/v3-ActIncidentCode | ||||
Claim.item.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
Claim.item.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-place from the FHIR Standard | ||||
Claim.item.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/tooth from the FHIR Standard | ||||
Claim.item.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surface from the FHIR Standard | ||||
Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard |
This structure is derived from Claim
Differential View
This structure is derived from Claim
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() |
Claim | |||
![]() ![]() ![]() |
0..0 | |||
![]() ![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Request Status Reason URL: https://profiles.ihe.net/ITI/FAIS/StructureDefinition/request-statusReason | |
![]() ![]() ![]() |
0..0 | |||
![]() ![]() ![]() |
||||
![]() ![]() ![]() ![]() |
0..1 | Reference(FAIS Claim Profile) | Reference to the related claim | |
![]() |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |
![]() ![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Request Status Reason URL: https://profiles.ihe.net/ITI/FAIS/StructureDefinition/request-statusReason | |
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
![]() ![]() ![]() |
Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | The recipient of the products and services |
![]() ![]() ![]() |
Σ | 1..1 | dateTime | Resource creation date |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim |
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
![]() ![]() ![]() |
Σ | 1..* | BackboneElement | Patient insurance information |
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() |
Σ | 1..1 | positiveInt | Insurance instance identifier |
![]() ![]() ![]() ![]() |
Σ | 1..1 | boolean | Coverage to be used for adjudication |
![]() ![]() ![]() ![]() |
Σ | 1..1 | Reference(Coverage) | Insurance information |
![]() |
Path | Conformance | ValueSet | URI |
Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | |
Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | |
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||
![]() ![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Request Status Reason URL: https://profiles.ihe.net/ITI/FAIS/StructureDefinition/request-statusReason | |||||
![]() ![]() ![]() |
0..* | Identifier | Business Identifier for claim | |||||
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
![]() ![]() ![]() |
0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |||||
![]() ![]() ![]() |
Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. | ||||
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | The recipient of the products and services | ||||
![]() ![]() ![]() |
Σ | 0..1 | Period | Relevant time frame for the claim | ||||
![]() ![]() ![]() |
Σ | 1..1 | dateTime | Resource creation date | ||||
![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||
![]() ![]() ![]() |
Σ | 0..1 | Reference(Organization) | Target | ||||
![]() ![]() ![]() |
Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim | ||||
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
![]() ![]() ![]() |
0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
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0..* | BackboneElement | Prior or corollary claims | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..1 | Reference(FAIS Claim Profile) | Reference to the related claim | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||
![]() ![]() ![]() ![]() |
0..1 | Identifier | File or case reference | |||||
![]() ![]() ![]() |
0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||
![]() ![]() ![]() |
0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||
![]() ![]() ![]() |
0..1 | BackboneElement | Recipient of benefits payable | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
![]() ![]() ![]() ![]() |
0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
![]() ![]() ![]() |
0..1 | Reference(ServiceRequest) | Treatment referral | |||||
![]() ![]() ![]() |
0..1 | Reference(Location) | Servicing facility | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Members of the care team | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Order of care team | |||||
![]() ![]() ![]() ![]() |
1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
![]() ![]() ![]() ![]() |
0..1 | boolean | Indicator of the lead practitioner | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |||||
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0..* | BackboneElement | Supporting information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
![]() ![]() ![]() ![]() |
0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() |
date | |||||||
![]() ![]() ![]() ![]() ![]() |
Period | |||||||
![]() ![]() ![]() ![]() |
0..1 | Data to be provided | ||||||
![]() ![]() ![]() ![]() ![]() |
boolean | |||||||
![]() ![]() ![]() ![]() ![]() |
string | |||||||
![]() ![]() ![]() ![]() ![]() |
Quantity | |||||||
![]() ![]() ![]() ![]() ![]() |
Attachment | |||||||
![]() ![]() ![]() ![]() ![]() |
Reference(Resource) | |||||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Pertinent diagnosis information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Diagnosis instance identifier | |||||
![]() ![]() ![]() ![]() |
1..1 | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||||||
![]() ![]() ![]() ![]() ![]() |
CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() |
Reference(Condition) | |||||||
![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Clinical procedures performed | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Procedure instance identifier | |||||
![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||
![]() ![]() ![]() ![]() |
0..1 | dateTime | When the procedure was performed | |||||
![]() ![]() ![]() ![]() |
1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||||||
![]() ![]() ![]() ![]() ![]() |
CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() |
Reference(Procedure) | |||||||
![]() ![]() ![]() ![]() |
0..* | Reference(Device) | Unique device identifier | |||||
![]() ![]() ![]() |
Σ | 1..* | BackboneElement | Patient insurance information | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | positiveInt | Insurance instance identifier | ||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | boolean | Coverage to be used for adjudication | ||||
![]() ![]() ![]() ![]() |
0..1 | Identifier | Pre-assigned Claim number | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | Reference(Coverage) | Insurance information | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |||||
![]() ![]() ![]() ![]() |
0..* | string | Prior authorization reference number | |||||
![]() ![]() ![]() ![]() |
0..1 | Reference(ClaimResponse) | Adjudication results | |||||
![]() ![]() ![]() |
0..1 | BackboneElement | Details of the event | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | date | When the incident occurred | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |||||
![]() ![]() ![]() ![]() |
0..1 | Where the event occurred | ||||||
![]() ![]() ![]() ![]() ![]() |
Address | |||||||
![]() ![]() ![]() ![]() ![]() |
Reference(Location) | |||||||
![]() ![]() ![]() |
0..* | BackboneElement | Product or service provided | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Item instance identifier | |||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable careTeam members | |||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable diagnoses | |||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable procedures | |||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable exception and supporting information | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
![]() ![]() ![]() ![]() |
0..1 | Date or dates of service or product delivery | ||||||
![]() ![]() ![]() ![]() ![]() |
date | |||||||
![]() ![]() ![]() ![]() ![]() |
Period | |||||||
![]() ![]() ![]() ![]() |
0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
![]() ![]() ![]() ![]() ![]() |
CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() |
Address | |||||||
![]() ![]() ![]() ![]() ![]() |
Reference(Location) | |||||||
![]() ![]() ![]() ![]() |
0..1 | SimpleQuantity | Count of products or services | |||||
![]() ![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() ![]() |
0..1 | decimal | Price scaling factor | |||||
![]() ![]() ![]() ![]() |
0..1 | Money | Total item cost | |||||
![]() ![]() ![]() ![]() |
0..* | Reference(Device) | Unique device identifier | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
![]() ![]() ![]() ![]() |
0..* | Reference(Encounter) | Encounters related to this billed item | |||||
![]() ![]() ![]() ![]() |
0..* | BackboneElement | Product or service provided | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() |
1..1 | positiveInt | Item instance identifier | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
![]() ![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | SimpleQuantity | Count of products or services | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | decimal | Price scaling factor | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Total item cost | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Reference(Device) | Unique device identifier | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | BackboneElement | Product or service provided | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | positiveInt | Item instance identifier | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | SimpleQuantity | Count of products or services | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | decimal | Price scaling factor | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Total item cost | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Reference(Device) | Unique device identifier | |||||
![]() ![]() ![]() |
0..1 | Money | Total claim cost | |||||
![]() |
Path | Conformance | ValueSet | URI | |||
Claim.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | ||||
Claim.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard | ||||
Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | ||||
Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard | ||||
Claim.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard | ||||
Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationship from the FHIR Standard | ||||
Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard | ||||
Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamrole from the FHIR Standard | ||||
Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualification from the FHIR Standard | ||||
Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory from the FHIR Standard | ||||
Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception from the FHIR Standard | ||||
Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reason from the FHIR Standard | ||||
Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard | ||||
Claim.diagnosis.type | example | ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype from the FHIR Standard | ||||
Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission from the FHIR Standard | ||||
Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup from the FHIR Standard | ||||
Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-type from the FHIR Standard | ||||
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-procedures from the FHIR Standard | ||||
Claim.accident.type | extensible | ActIncidentCodehttp://terminology.hl7.org/ValueSet/v3-ActIncidentCode | ||||
Claim.item.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
Claim.item.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-place from the FHIR Standard | ||||
Claim.item.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/tooth from the FHIR Standard | ||||
Claim.item.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surface from the FHIR Standard | ||||
Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard | ||||
Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard | ||||
Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard |
This structure is derived from Claim
Other representations of profile: CSV, Excel, Schematron