Name Flags Card. Type Description & Constraints doco
. . 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

doco Documentation for this format