<status value="active" /> <experimental value="false" /> <description value="A common set of information used when representing Claim information, regardless of context" /> <fhirVersion value="5.0.0" /> <mapping> <identity value="BPCS" /> <name value="Internal BPCS API" /> </mapping> <kind value="resource" /> <abstract value="true" /> <type value="Claim" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Claim" /> <derivation value="constraint" /> <differential> <element id="Claim.contained"> <path value="Claim.contained" /> <slicing> <discriminator> <type value="profile" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="Claim.contained:dispenses"> <path value="Claim.contained" /> <sliceName value="dispenses" /> <type> <code value="MedicationDispense" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-MedicationDispense" /> </type> <mustSupport value="true" /> </element> <element id="Claim.status"> <path value="Claim.status" /> <short value="draft | active" /> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-FinancialStatus" /> </binding> <mapping> <identity value="BPCS" /> <map value="BatchRecordDTO.batchStatus" /> </mapping> </element> <element id="Claim.type"> <path value="Claim.type" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/claim-type" /> <code value="pharmacy" /> </coding> </patternCodeableConcept> </element> <element id="Claim.use"> <path value="Claim.use" /> <patternCode value="claim" /> </element> <element id="Claim.patient"> <path value="Claim.patient" /> <comment value="If the patient has Trillium coverage, the Claim must be submitted as a 'group' Claim, tied to the family (possibly including receipts from multiple family members). In all other cases, the Claim must be submitted as an individual Claim, tied to a single Patient" /> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-create" /> </type> <mustSupport value="true" /> </element> <element id="Claim.created"> <path value="Claim.created" /> <comment value="This is set to the current date" /> <mustSupport value="true" /> </element> <element id="Claim.insurer"> <path value="Claim.insurer" /> <patternReference> <reference value="Organization/bpcs" /> </patternReference> </element> <element id="Claim.supportingInfo"> <path value="Claim.supportingInfo" /> <slicing> <discriminator> <type value="type" /> <path value="category" /> </discriminator> <discriminator> <type value="type" /> <path value="value" /> </discriminator> <discriminator> <type value="profile" /> <path value="value.resolve()" /> </discriminator> <rules value="open" /> </slicing> <comment value="There will be at least one supportingInformation for each receipt containing the dispense information associated with that receipt" /> <mustSupport value="true" /> </element> <element id="Claim.supportingInfo.sequence"> <path value="Claim.supportingInfo.sequence" /> <comment value="This is a unique sequential integer (starting with 1) - one per dispense" /> <mustSupport value="true" /> </element> <element id="Claim.supportingInfo:dispense"> <path value="Claim.supportingInfo" /> <sliceName value="dispense" /> <comment value="Pointed to by item.informationSequence" /> <mustSupport value="true" /> </element> <element id="Claim.supportingInfo:dispense.category"> <path value="Claim.supportingInfo.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/claiminformationcategory" /> <code value="info" /> </coding> </patternCodeableConcept> </element> <element id="Claim.supportingInfo:dispense.value[x]"> <path value="Claim.supportingInfo.value[x]" /> <min value="1" /> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-MedicationDispense" /> <aggregation value="contained" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.drug" /> </mapping> </element> </differential> </StructureDefinition>