Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Claim | Σ | DomainResource | Claim, Pre-determination or Pre-authorization | |
type | Σ | 1..1 | code | institutional | oral | pharmacy | professional | vision
ClaimType ( Required) |
identifier | Σ | 0..* | Identifier | Claim number |
ruleset | Σ | 0..1 | Coding | Current specification followed
Ruleset Codes ( Example) |
originalRuleset | Σ | 0..1 | Coding | Original specification followed
Ruleset Codes ( Example) |
created | Σ | 0..1 | dateTime | Creation date |
target | Σ | 0..1 | Reference( Organization) | Insurer |
provider | Σ | 0..1 | Reference( Practitioner) | Responsible provider |
organization | Σ | 0..1 | Reference( Organization) | Responsible organization |
use | Σ | 0..1 | code | complete | proposed | exploratory | other
Use ( Required) |
priority | Σ | 0..1 | Coding | Desired processing priority
Priority Codes ( Example) |
fundsReserve | Σ | 0..1 | Coding | Funds requested to be reserved
Funds Reservation Codes ( Example) |
enterer | Σ | 0..1 | Reference( Practitioner) | Author |
facility | Σ | 0..1 | Reference( Location) | Servicing Facility |
prescription | Σ | 0..1 | Reference( MedicationOrder | VisionPrescription) | Prescription |
originalPrescription | Σ | 0..1 | Reference( MedicationOrder) | Original Prescription |
payee | Σ | 0..1 | BackboneElement | Payee |
type | Σ | 0..1 | Coding | Party to be paid any benefits payable
Payee Type Codes ( Example) |
provider | Σ | 0..1 | Reference( Practitioner) | Provider who is the payee |
organization | Σ | 0..1 | Reference( Organization) | Organization who is the payee |
person | Σ | 0..1 | Reference( Patient) | Other person who is the payee |
referral | Σ | 0..1 | Reference( ReferralRequest) | Treatment Referral |
diagnosis | Σ | 0..* | BackboneElement | Diagnosis |
sequence | Σ | 1..1 | positiveInt | Sequence of diagnosis |
diagnosis | Σ | 1..1 | Coding | Patient's list of diagnosis
ICD-10 Codes ( Example) |
condition | Σ | 0..* | Coding | List of presenting Conditions
Conditions Codes ( Example) |
patient | Σ | 1..1 | Reference( Patient) | The subject of the Products and Services |
coverage | Σ | 0..* | BackboneElement | Insurance or medical plan |
sequence | Σ | 1..1 | positiveInt | Service instance identifier |
focal | Σ | 1..1 | boolean | The focal Coverage |
coverage | Σ | 1..1 | Reference( Coverage) | Insurance information |
businessArrangement | Σ | 0..1 | string | Business agreement |
relationship | Σ | 1..1 | Coding | Patient relationship to subscriber
Surface Codes ( Example) |
preAuthRef | Σ | 0..* | string | Pre-Authorization/Determination Reference |
claimResponse | Σ | 0..1 | Reference( ClaimResponse) | Adjudication results |
originalRuleset | Σ | 0..1 | Coding | Original version
Ruleset Codes ( Example) |
exception | Σ | 0..* | Coding | Eligibility exceptions
Exception Codes ( Example) |
school | Σ | 0..1 | string | Name of School |
accident | Σ | 0..1 | date | Accident Date |
accidentType | Σ | 0..1 | Coding | Accident Type
ActIncidentCode ( Required) |
interventionException | Σ | 0..* | Coding | Intervention and exception code (Pharma)
Intervention Codes ( Example) |
item | Σ | 0..* | BackboneElement | Goods and Services |
sequence | Σ | 1..1 | positiveInt | Service instance |
type | Σ | 1..1 | Coding | Group or type of product or service
ActInvoiceGroupCode ( Required) |
provider | Σ | 0..1 | Reference( Practitioner) | Responsible practitioner |
diagnosisLinkId | Σ | 0..* | positiveInt | Diagnosis Link |
service | Σ | 1..1 | Coding | Item Code
USCLS Codes ( Example) |
serviceDate | Σ | 0..1 | date | Date of Service |
quantity | Σ | 0..1 | SimpleQuantity | Count of Products or Services |
unitPrice | Σ | 0..1 | Money | Fee, charge or cost per point |
factor | Σ | 0..1 | decimal | Price scaling factor |
points | Σ | 0..1 | decimal | Difficulty scaling factor |
net | Σ | 0..1 | Money | Total item cost |
udi | Σ | 0..1 | Coding | Unique Device Identifier
UDI Codes ( Example) |
bodySite | Σ | 0..1 | Coding | Service Location
Surface Codes ( Example) |
subSite | Σ | 0..* | Coding | Service Sub-location
Surface Codes ( Example) |
modifier | Σ | 0..* | Coding | Service/Product billing modifiers
Modifier type Codes ( Example) |
detail | Σ | 0..* | BackboneElement | Additional items |
sequence | Σ | 1..1 | positiveInt | Service instance |
type | Σ | 1..1 | Coding | Group or type of product or service
ActInvoiceGroupCode ( Required) |
service | Σ | 1..1 | Coding | Additional item codes
USCLS Codes ( Example) |
quantity | Σ | 0..1 | SimpleQuantity | Count of Products or Services |
unitPrice | Σ | 0..1 | Money | Fee, charge or cost per point |
factor | Σ | 0..1 | decimal | Price scaling factor |
points | Σ | 0..1 | decimal | Difficulty scaling factor |
net | Σ | 0..1 | Money | Total additional item cost |
udi | Σ | 0..1 | Coding | Unique Device Identifier
UDI Codes ( Example) |
subDetail | Σ | 0..* | BackboneElement | Additional items |
sequence | Σ | 1..1 | positiveInt | Service instance |
type | Σ | 1..1 | Coding | Type of product or service
ActInvoiceGroupCode ( Required) |
service | Σ | 1..1 | Coding | Additional item codes
USCLS Codes ( Example) |
quantity | Σ | 0..1 | SimpleQuantity | Count of Products or Services |
unitPrice | Σ | 0..1 | Money | Fee, charge or cost per point |
factor | Σ | 0..1 | decimal | Price scaling factor |
points | Σ | 0..1 | decimal | Difficulty scaling factor |
net | Σ | 0..1 | Money | Net additional item cost |
udi | Σ | 0..1 | Coding | Unique Device Identifier
UDI Codes ( Example) |
prosthesis | Σ | 0..1 | BackboneElement | Prosthetic details |
initial | Σ | 0..1 | boolean | Is this the initial service |
priorDate | Σ | 0..1 | date | Initial service Date |
priorMaterial | Σ | 0..1 | Coding | Prosthetic Material
Oral Prostho Material type Codes ( Example) |
additionalMaterials | Σ | 0..* | Coding | Additional materials, documents, etc.
Additional Material Codes ( Example) |
missingTeeth | Σ | 0..* | BackboneElement | Only if type = oral |
tooth | Σ | 1..1 | Coding | Tooth Code
Teeth Codes ( Example) |
reason | Σ | 0..1 | Coding | Reason for missing
Missing Tooth Reason Codes ( Example) |
extractionDate | Σ | 0..1 | date | Date of Extraction |
Documentation for this format |