This is the set of resources that conform to either of the profiles FAIS Claim Profile (https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim) and FAIS Claim Profile (https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim). E.g. what you have to deal with if you get resources conforming to one of them
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | 0..* | Claim, Pre-determination or Pre-authorization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management | ||
meta | Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children |
language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children | |
text | 0..1 | Narrative | Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children | |
contained | 0..* | Resource | Contained, inline Resources | |
extension | 0..* | Extension | left: Additional content defined by implementations; right: Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
identifier | 0..* | Identifier | Business Identifier for claim ele-1: All FHIR elements must have a @value or children | |
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children |
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children |
subType | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children | |
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim. ele-1: All FHIR elements must have a @value or children |
patient | Σ | 1..1 | Reference(Patient) | The recipient of the products and services ele-1: All FHIR elements must have a @value or children |
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim ele-1: All FHIR elements must have a @value or children |
created | Σ | 1..1 | dateTime | Resource creation date ele-1: All FHIR elements must have a @value or children |
enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim ele-1: All FHIR elements must have a @value or children | |
insurer | Σ | 0..1 | Reference(Organization) | Target ele-1: All FHIR elements must have a @value or children |
provider | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim ele-1: All FHIR elements must have a @value or children |
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred. ele-1: All FHIR elements must have a @value or children |
fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). ele-1: All FHIR elements must have a @value or children | |
related | 0..* | BackboneElement | Prior or corollary claims ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
claim | 0..1 | Reference(FAIS Claim Profile), Reference(FAIS Claim Profile) | Reference to the related claim ele-1: All FHIR elements must have a @value or children | |
relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. ele-1: All FHIR elements must have a @value or children | |
reference | 0..1 | Identifier | File or case reference ele-1: All FHIR elements must have a @value or children | |
prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products ele-1: All FHIR elements must have a @value or children | |
originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller ele-1: All FHIR elements must have a @value or children | |
payee | 0..1 | BackboneElement | Recipient of benefits payable ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
type | 1..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. ele-1: All FHIR elements must have a @value or children | |
party | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference ele-1: All FHIR elements must have a @value or children | |
referral | 0..1 | Reference(ServiceRequest) | Treatment referral ele-1: All FHIR elements must have a @value or children | |
facility | 0..1 | Reference(Location) | Servicing facility ele-1: All FHIR elements must have a @value or children | |
careTeam | 0..* | BackboneElement | Members of the care team ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
sequence | 1..1 | positiveInt | Order of care team ele-1: All FHIR elements must have a @value or children | |
provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization ele-1: All FHIR elements must have a @value or children | |
responsible | 0..1 | boolean | Indicator of the lead practitioner ele-1: All FHIR elements must have a @value or children | |
role | 0..1 | CodeableConcept | Function within the team Binding: ?? (example): The role codes for the care team members. ele-1: All FHIR elements must have a @value or children | |
qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. ele-1: All FHIR elements must have a @value or children | |
supportingInfo | 0..* | BackboneElement | Supporting information ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
sequence | 1..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (example): The valuset used for additional information category codes. ele-1: All FHIR elements must have a @value or children | |
code | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. ele-1: All FHIR elements must have a @value or children | |
timing[x] | 0..1 | When it occurred ele-1: All FHIR elements must have a @value or children | ||
timingDate | date | |||
timingPeriod | Period | |||
value[x] | 0..1 | Data to be provided ele-1: All FHIR elements must have a @value or children | ||
valueBoolean | boolean | |||
valueString | string | |||
valueQuantity | Quantity | |||
valueAttachment | Attachment | |||
valueReference | Reference(Resource) | |||
reason | 0..1 | CodeableConcept | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. ele-1: All FHIR elements must have a @value or children | |
diagnosis | 0..* | BackboneElement | Pertinent diagnosis information ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
sequence | 1..1 | positiveInt | Diagnosis instance identifier ele-1: All FHIR elements must have a @value or children | |
diagnosis[x] | 1..1 | Nature of illness or problem Binding: ?? (example): Example ICD10 Diagnostic codes. ele-1: All FHIR elements must have a @value or children | ||
diagnosisCodeableConcept | CodeableConcept | |||
diagnosisReference | Reference(Condition) | |||
type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. ele-1: All FHIR elements must have a @value or children | |
onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. ele-1: All FHIR elements must have a @value or children | |
packageCode | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. ele-1: All FHIR elements must have a @value or children | |
procedure | 0..* | BackboneElement | Clinical procedures performed ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
sequence | 1..1 | positiveInt | Procedure instance identifier ele-1: All FHIR elements must have a @value or children | |
type | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. ele-1: All FHIR elements must have a @value or children | |
date | 0..1 | dateTime | When the procedure was performed ele-1: All FHIR elements must have a @value or children | |
procedure[x] | 1..1 | Specific clinical procedure Binding: ?? (example): Example ICD10 Procedure codes. ele-1: All FHIR elements must have a @value or children | ||
procedureCodeableConcept | CodeableConcept | |||
procedureReference | Reference(Procedure) | |||
udi | 0..* | Reference(Device) | Unique device identifier ele-1: All FHIR elements must have a @value or children | |
insurance | Σ | 1..* | BackboneElement | Patient insurance information ele-1: All FHIR elements must have a @value or children |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier ele-1: All FHIR elements must have a @value or children |
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children |
identifier | 0..1 | Identifier | Pre-assigned Claim number ele-1: All FHIR elements must have a @value or children | |
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information ele-1: All FHIR elements must have a @value or children |
businessArrangement | 0..1 | string | Additional provider contract number ele-1: All FHIR elements must have a @value or children | |
preAuthRef | 0..* | string | Prior authorization reference number ele-1: All FHIR elements must have a @value or children | |
claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results ele-1: All FHIR elements must have a @value or children | |
accident | 0..1 | BackboneElement | Details of the event ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
date | 1..1 | date | When the incident occurred ele-1: All FHIR elements must have a @value or children | |
type | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. ele-1: All FHIR elements must have a @value or children | |
location[x] | 0..1 | Where the event occurred ele-1: All FHIR elements must have a @value or children | ||
locationAddress | Address | |||
locationReference | Reference(Location) | |||
item | 0..* | BackboneElement | Product or service provided ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
sequence | 1..1 | positiveInt | Item instance identifier ele-1: All FHIR elements must have a @value or children | |
careTeamSequence | 0..* | positiveInt | Applicable careTeam members ele-1: All FHIR elements must have a @value or children | |
diagnosisSequence | 0..* | positiveInt | Applicable diagnoses ele-1: All FHIR elements must have a @value or children | |
procedureSequence | 0..* | positiveInt | Applicable procedures ele-1: All FHIR elements must have a @value or children | |
informationSequence | 0..* | positiveInt | Applicable exception and supporting information ele-1: All FHIR elements must have a @value or children | |
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children | |
category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. ele-1: All FHIR elements must have a @value or children | |
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children | |
modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ?? (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. ele-1: All FHIR elements must have a @value or children | |
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children | |
serviced[x] | 0..1 | Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children | ||
servicedDate | date | |||
servicedPeriod | Period | |||
location[x] | 0..1 | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. ele-1: All FHIR elements must have a @value or children | ||
locationCodeableConcept | CodeableConcept | |||
locationAddress | Address | |||
locationReference | Reference(Location) | |||
quantity | 0..1 | ?? | Count of products or services ele-1: All FHIR elements must have a @value or children | |
unitPrice | 0..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |
net | 0..1 | Money | Total item cost ele-1: All FHIR elements must have a @value or children | |
udi | 0..* | Reference(Device) | Unique device identifier ele-1: All FHIR elements must have a @value or children | |
bodySite | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. ele-1: All FHIR elements must have a @value or children | |
subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. ele-1: All FHIR elements must have a @value or children | |
encounter | 0..* | Reference(Encounter) | Encounters related to this billed item ele-1: All FHIR elements must have a @value or children | |
detail | 0..* | BackboneElement | Product or service provided ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
sequence | 1..1 | positiveInt | Item instance identifier ele-1: All FHIR elements must have a @value or children | |
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children | |
category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. ele-1: All FHIR elements must have a @value or children | |
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children | |
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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. ele-1: All FHIR elements must have a @value or children | |
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children | |
quantity | 0..1 | ?? | Count of products or services ele-1: All FHIR elements must have a @value or children | |
unitPrice | 0..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |
net | 0..1 | Money | Total item cost ele-1: All FHIR elements must have a @value or children | |
udi | 0..* | Reference(Device) | Unique device identifier ele-1: All FHIR elements must have a @value or children | |
subDetail | 0..* | BackboneElement | Product or service provided ele-1: All FHIR elements must have a @value or children | |
extension | 0..* | Extension | Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
sequence | 1..1 | positiveInt | Item instance identifier ele-1: All FHIR elements must have a @value or children | |
revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children | |
category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses. ele-1: All FHIR elements must have a @value or children | |
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children | |
modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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. ele-1: All FHIR elements must have a @value or children | |
programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children | |
quantity | 0..1 | ?? | Count of products or services ele-1: All FHIR elements must have a @value or children | |
unitPrice | 0..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |
net | 0..1 | Money | Total item cost ele-1: All FHIR elements must have a @value or children | |
udi | 0..* | Reference(Device) | Unique device identifier ele-1: All FHIR elements must have a @value or children | |
total | 0..1 | Money | Total claim cost ele-1: All FHIR elements must have a @value or children | |
Documentation for this format |