<status value="active" /> <experimental value="false" /> <description value="Information about a claim used when submitting the claim for adjudication" /> <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="https://bpcs.exchange/fhir/StructureDefinition/profile-Claim-create" /> <derivation value="constraint" /> <differential> <element id="Claim.item"> <path value="Claim.item" /> <constraint> <key value="bpcs-clm-1" /> <severity value="error" /> <human value="The override reason must be present if one of the modifiers is 'Accept' or if the amount has been overridden" /> <expression value="modifier.coding.exists(system='https://bpcs.exchange/fhir/CodeSystem/cs-ClaimModifier' and code='ACPT') or extension('https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverrideNet').exists() implies extension('https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverrideReason').exists()" /> </constraint> </element> <element id="Claim.item.extension:overriddenReasons"> <path value="Claim.item.extension" /> <sliceName value="overriddenReasons" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverriddenReasons" /> </type> </element> <element id="Claim.item.extension:overrideReason"> <path value="Claim.item.extension" /> <sliceName value="overrideReason" /> <comment value="This must be present if the original adjudication has been overridden to accept or reject the claim, if the amount has been overridden, or if any of the messages have been overridden" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverrideReason" /> </type> <condition value="bpcs-clm-1" /> </element> <element id="Claim.item.modifier.extension:duplicateVersion"> <path value="Claim.item.modifier.extension" /> <sliceName value="duplicateVersion" /> <definition value="This is the version of the receipt as identified in the EOB that was selected by the user as being the duplicate" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-DuplicateVersion" /> </type> <mustSupport value="true" /> </element> </differential> </StructureDefinition>