Resource Profile: DXP Claim

The Claim is used by providers and payors, insurers, to exchange the financial information, and supporting clinical information, regarding the provision of health care services with payors and for reporting to regulatory bodies and firms which provide data analytics. The primary uses of this resource is to support eClaims, the exchange of information relating to the proposed or actual provision of healthcare-related goods and services for patients to their benefit payors, insurers and national health programs, for treatment payment planning and reimbursement.

Differential View of Profile Content

versionIdΣ0..1id
lastUpdatedS Σ0..1instant
sourceΣ0..1uri
profileΣ0..*canonical(StructureDefinition)
securityΣ0..*CodingBinding
tagΣ0..*Coding
identifier0..*Identifier
statusS Σ ?!1..1codeBinding
typeS Σ1..1CodeableConceptBinding
subType0..1CodeableConcept
useΣ1..1codeBinding
patientΣ I1..1Reference(Patient)
billablePeriodΣ I0..1Period
createdΣ1..1dateTime
entererI0..1Reference(Practitioner | PractitionerRole)
insurerΣ I0..1Reference(Organization)
providerΣ I1..1Reference(Practitioner | PractitionerRole | Organization)
priorityΣ1..1CodeableConcept
fundsReserve0..1CodeableConcept
claimI0..1Reference(Claim)
relationship0..1CodeableConcept
reference0..1Identifier
prescriptionI0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)
originalPrescriptionI0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)
type1..1CodeableConcept
partyI0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)
referralI0..1Reference(ServiceRequest)
facilityI0..1Reference(Location)
sequence1..1positiveInt
providerI1..1Reference(Practitioner | PractitionerRole | Organization)
responsible0..1boolean
role0..1CodeableConcept
qualification0..1CodeableConcept
sequence1..1positiveInt
category1..1CodeableConcept
code0..1CodeableConcept
timingDatedate
timingPeriodPeriod
valueBooleanboolean
valueStringstring
valueQuantityQuantity
valueAttachmentAttachment
valueReferenceReference(Resource)
reason0..1CodeableConcept
sequence1..1positiveInt
diagnosisCodeableConceptCodeableConcept
diagnosisReferenceReference(Condition)
type0..*CodeableConcept
onAdmission0..1CodeableConcept
packageCode0..1CodeableConcept
sequence1..1positiveInt
type0..*CodeableConcept
date0..1dateTime
procedureCodeableConceptCodeableConcept
procedureReferenceReference(Procedure)
udiI0..*Reference(Device)
sequenceΣ1..1positiveInt
focalΣ1..1boolean
identifier0..1Identifier
coverageΣ I1..1Reference(Coverage)
businessArrangement0..1string
preAuthRef0..*string
claimResponseI0..1Reference(ClaimResponse)
date1..1date
type0..1CodeableConceptBinding
locationAddressAddress
locationReferenceReference(Location)
sequence1..1positiveInt
careTeamSequence0..*positiveInt
diagnosisSequence0..*positiveInt
procedureSequence0..*positiveInt
informationSequence0..*positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
servicedDatedate
servicedPeriodPeriod
locationCodeableConceptCodeableConcept
locationAddressAddress
locationReferenceReference(Location)
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
bodySite0..1CodeableConcept
subSite0..*CodeableConcept
encounterI0..*Reference(Encounter)
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
total0..1Money

Hybrid View of Profile Content

versionIdΣ0..1id
lastUpdatedS Σ0..1instant
sourceΣ0..1uri
profileΣ0..*canonical(StructureDefinition)
securityΣ0..*CodingBinding
tagΣ0..*Coding
identifier0..*Identifier
statusS Σ ?!1..1codeBinding
typeS Σ1..1CodeableConceptBinding
subType0..1CodeableConcept
useΣ1..1codeBinding
patientΣ I1..1Reference(Patient)
billablePeriodΣ I0..1Period
createdΣ1..1dateTime
entererI0..1Reference(Practitioner | PractitionerRole)
insurerΣ I0..1Reference(Organization)
providerΣ I1..1Reference(Practitioner | PractitionerRole | Organization)
priorityΣ1..1CodeableConcept
fundsReserve0..1CodeableConcept
claimI0..1Reference(Claim)
relationship0..1CodeableConcept
reference0..1Identifier
prescriptionI0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)
originalPrescriptionI0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)
type1..1CodeableConcept
partyI0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)
referralI0..1Reference(ServiceRequest)
facilityI0..1Reference(Location)
sequence1..1positiveInt
providerI1..1Reference(Practitioner | PractitionerRole | Organization)
responsible0..1boolean
role0..1CodeableConcept
qualification0..1CodeableConcept
sequence1..1positiveInt
category1..1CodeableConcept
code0..1CodeableConcept
timingDatedate
timingPeriodPeriod
valueBooleanboolean
valueStringstring
valueQuantityQuantity
valueAttachmentAttachment
valueReferenceReference(Resource)
reason0..1CodeableConcept
sequence1..1positiveInt
diagnosisCodeableConceptCodeableConcept
diagnosisReferenceReference(Condition)
type0..*CodeableConcept
onAdmission0..1CodeableConcept
packageCode0..1CodeableConcept
sequence1..1positiveInt
type0..*CodeableConcept
date0..1dateTime
procedureCodeableConceptCodeableConcept
procedureReferenceReference(Procedure)
udiI0..*Reference(Device)
sequenceΣ1..1positiveInt
focalΣ1..1boolean
identifier0..1Identifier
coverageΣ I1..1Reference(Coverage)
businessArrangement0..1string
preAuthRef0..*string
claimResponseI0..1Reference(ClaimResponse)
date1..1date
type0..1CodeableConceptBinding
locationAddressAddress
locationReferenceReference(Location)
sequence1..1positiveInt
careTeamSequence0..*positiveInt
diagnosisSequence0..*positiveInt
procedureSequence0..*positiveInt
informationSequence0..*positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
servicedDatedate
servicedPeriodPeriod
locationCodeableConceptCodeableConcept
locationAddressAddress
locationReferenceReference(Location)
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
bodySite0..1CodeableConcept
subSite0..*CodeableConcept
encounterI0..*Reference(Encounter)
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
total0..1Money

Snapshot View of Profile Content

versionIdΣ0..1id
lastUpdatedS Σ0..1instant
sourceΣ0..1uri
profileΣ0..*canonical(StructureDefinition)
securityΣ0..*CodingBinding
tagΣ0..*Coding
identifier0..*Identifier
statusS Σ ?!1..1codeBinding
typeS Σ1..1CodeableConceptBinding
subType0..1CodeableConcept
useΣ1..1codeBinding
patientΣ I1..1Reference(Patient)
billablePeriodΣ I0..1Period
createdΣ1..1dateTime
entererI0..1Reference(Practitioner | PractitionerRole)
insurerΣ I0..1Reference(Organization)
providerΣ I1..1Reference(Practitioner | PractitionerRole | Organization)
priorityΣ1..1CodeableConcept
fundsReserve0..1CodeableConcept
claimI0..1Reference(Claim)
relationship0..1CodeableConcept
reference0..1Identifier
prescriptionI0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)
originalPrescriptionI0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)
type1..1CodeableConcept
partyI0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)
referralI0..1Reference(ServiceRequest)
facilityI0..1Reference(Location)
sequence1..1positiveInt
providerI1..1Reference(Practitioner | PractitionerRole | Organization)
responsible0..1boolean
role0..1CodeableConcept
qualification0..1CodeableConcept
sequence1..1positiveInt
category1..1CodeableConcept
code0..1CodeableConcept
timingDatedate
timingPeriodPeriod
valueBooleanboolean
valueStringstring
valueQuantityQuantity
valueAttachmentAttachment
valueReferenceReference(Resource)
reason0..1CodeableConcept
sequence1..1positiveInt
diagnosisCodeableConceptCodeableConcept
diagnosisReferenceReference(Condition)
type0..*CodeableConcept
onAdmission0..1CodeableConcept
packageCode0..1CodeableConcept
sequence1..1positiveInt
type0..*CodeableConcept
date0..1dateTime
procedureCodeableConceptCodeableConcept
procedureReferenceReference(Procedure)
udiI0..*Reference(Device)
sequenceΣ1..1positiveInt
focalΣ1..1boolean
identifier0..1Identifier
coverageΣ I1..1Reference(Coverage)
businessArrangement0..1string
preAuthRef0..*string
claimResponseI0..1Reference(ClaimResponse)
date1..1date
type0..1CodeableConceptBinding
locationAddressAddress
locationReferenceReference(Location)
sequence1..1positiveInt
careTeamSequence0..*positiveInt
diagnosisSequence0..*positiveInt
procedureSequence0..*positiveInt
informationSequence0..*positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
servicedDatedate
servicedPeriodPeriod
locationCodeableConceptCodeableConcept
locationAddressAddress
locationReferenceReference(Location)
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
bodySite0..1CodeableConcept
subSite0..*CodeableConcept
encounterI0..*Reference(Encounter)
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
total0..1Money

Tabular View of Profile Content

Claim0..*
Claim.idSystem.String0..1
Claim.metaMeta0..1
Claim.meta.idSystem.String0..1
Claim.meta.extensionExtension0..*
Claim.meta.versionIdid0..1
Claim.meta.lastUpdatedinstant0..1
Claim.meta.sourceuri0..1
Claim.meta.profilecanonical(StructureDefinition)0..*
Claim.meta.securityCoding0..*
Claim.meta.tagCoding0..*
Claim.implicitRulesuri0..1
Claim.languagecode0..1
Claim.textNarrative0..1
Claim.containedResource0..*
Claim.extensionExtension0..*
Claim.modifierExtensionExtension0..*
Claim.identifierIdentifier0..*
Claim.statuscode1..1
Claim.typeCodeableConcept1..1
Claim.subTypeCodeableConcept0..1
Claim.usecode1..1
Claim.patientReference(Patient)1..1
Claim.billablePeriodPeriod0..1
Claim.createddateTime1..1
Claim.entererReference(Practitioner | PractitionerRole)0..1
Claim.insurerReference(Organization)0..1
Claim.providerReference(Practitioner | PractitionerRole | Organization)1..1
Claim.priorityCodeableConcept1..1
Claim.fundsReserveCodeableConcept0..1
Claim.relatedBackboneElement0..*
Claim.related.idSystem.String0..1
Claim.related.extensionExtension0..*
Claim.related.modifierExtensionExtension0..*
Claim.related.claimReference(Claim)0..1
Claim.related.relationshipCodeableConcept0..1
Claim.related.referenceIdentifier0..1
Claim.prescriptionReference(DeviceRequest | MedicationRequest | VisionPrescription)0..1
Claim.originalPrescriptionReference(DeviceRequest | MedicationRequest | VisionPrescription)0..1
Claim.payeeBackboneElement0..1
Claim.payee.idSystem.String0..1
Claim.payee.extensionExtension0..*
Claim.payee.modifierExtensionExtension0..*
Claim.payee.typeCodeableConcept1..1
Claim.payee.partyReference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)0..1
Claim.referralReference(ServiceRequest)0..1
Claim.facilityReference(Location)0..1
Claim.careTeamBackboneElement0..*
Claim.careTeam.idSystem.String0..1
Claim.careTeam.extensionExtension0..*
Claim.careTeam.modifierExtensionExtension0..*
Claim.careTeam.sequencepositiveInt1..1
Claim.careTeam.providerReference(Practitioner | PractitionerRole | Organization)1..1
Claim.careTeam.responsibleboolean0..1
Claim.careTeam.roleCodeableConcept0..1
Claim.careTeam.qualificationCodeableConcept0..1
Claim.supportingInfoBackboneElement0..*
Claim.supportingInfo.idSystem.String0..1
Claim.supportingInfo.extensionExtension0..*
Claim.supportingInfo.modifierExtensionExtension0..*
Claim.supportingInfo.sequencepositiveInt1..1
Claim.supportingInfo.categoryCodeableConcept1..1
Claim.supportingInfo.codeCodeableConcept0..1
Claim.supportingInfo.timing[x]date, Period0..1
Claim.supportingInfo.value[x]boolean, string, Quantity, Attachment, Reference(Resource)0..1
Claim.supportingInfo.reasonCodeableConcept0..1
Claim.diagnosisBackboneElement0..*
Claim.diagnosis.idSystem.String0..1
Claim.diagnosis.extensionExtension0..*
Claim.diagnosis.modifierExtensionExtension0..*
Claim.diagnosis.sequencepositiveInt1..1
Claim.diagnosis.diagnosis[x]CodeableConcept, Reference(Condition)1..1
Claim.diagnosis.typeCodeableConcept0..*
Claim.diagnosis.onAdmissionCodeableConcept0..1
Claim.diagnosis.packageCodeCodeableConcept0..1
Claim.procedureBackboneElement0..*
Claim.procedure.idSystem.String0..1
Claim.procedure.extensionExtension0..*
Claim.procedure.modifierExtensionExtension0..*
Claim.procedure.sequencepositiveInt1..1
Claim.procedure.typeCodeableConcept0..*
Claim.procedure.datedateTime0..1
Claim.procedure.procedure[x]CodeableConcept, Reference(Procedure)1..1
Claim.procedure.udiReference(Device)0..*
Claim.insuranceBackboneElement1..*
Claim.insurance.idSystem.String0..1
Claim.insurance.extensionExtension0..*
Claim.insurance.modifierExtensionExtension0..*
Claim.insurance.sequencepositiveInt1..1
Claim.insurance.focalboolean1..1
Claim.insurance.identifierIdentifier0..1
Claim.insurance.coverageReference(Coverage)1..1
Claim.insurance.businessArrangementstring0..1
Claim.insurance.preAuthRefstring0..*
Claim.insurance.claimResponseReference(ClaimResponse)0..1
Claim.accidentBackboneElement0..1
Claim.accident.idSystem.String0..1
Claim.accident.extensionExtension0..*
Claim.accident.modifierExtensionExtension0..*
Claim.accident.datedate1..1
Claim.accident.typeCodeableConcept0..1
Claim.accident.location[x]Address, Reference(Location)0..1
Claim.itemBackboneElement0..*
Claim.item.idSystem.String0..1
Claim.item.extensionExtension0..*
Claim.item.modifierExtensionExtension0..*
Claim.item.sequencepositiveInt1..1
Claim.item.careTeamSequencepositiveInt0..*
Claim.item.diagnosisSequencepositiveInt0..*
Claim.item.procedureSequencepositiveInt0..*
Claim.item.informationSequencepositiveInt0..*
Claim.item.revenueCodeableConcept0..1
Claim.item.categoryCodeableConcept0..1
Claim.item.productOrServiceCodeableConcept1..1
Claim.item.modifierCodeableConcept0..*
Claim.item.programCodeCodeableConcept0..*
Claim.item.serviced[x]date, Period0..1
Claim.item.location[x]CodeableConcept, Address, Reference(Location)0..1
Claim.item.quantitySimpleQuantity0..1
Claim.item.unitPriceMoney0..1
Claim.item.factordecimal0..1
Claim.item.netMoney0..1
Claim.item.udiReference(Device)0..*
Claim.item.bodySiteCodeableConcept0..1
Claim.item.subSiteCodeableConcept0..*
Claim.item.encounterReference(Encounter)0..*
Claim.item.detailBackboneElement0..*
Claim.item.detail.idSystem.String0..1
Claim.item.detail.extensionExtension0..*
Claim.item.detail.modifierExtensionExtension0..*
Claim.item.detail.sequencepositiveInt1..1
Claim.item.detail.revenueCodeableConcept0..1
Claim.item.detail.categoryCodeableConcept0..1
Claim.item.detail.productOrServiceCodeableConcept1..1
Claim.item.detail.modifierCodeableConcept0..*
Claim.item.detail.programCodeCodeableConcept0..*
Claim.item.detail.quantitySimpleQuantity0..1
Claim.item.detail.unitPriceMoney0..1
Claim.item.detail.factordecimal0..1
Claim.item.detail.netMoney0..1
Claim.item.detail.udiReference(Device)0..*
Claim.item.detail.subDetailBackboneElement0..*
Claim.item.detail.subDetail.idSystem.String0..1
Claim.item.detail.subDetail.extensionExtension0..*
Claim.item.detail.subDetail.modifierExtensionExtension0..*
Claim.item.detail.subDetail.sequencepositiveInt1..1
Claim.item.detail.subDetail.revenueCodeableConcept0..1
Claim.item.detail.subDetail.categoryCodeableConcept0..1
Claim.item.detail.subDetail.productOrServiceCodeableConcept1..1
Claim.item.detail.subDetail.modifierCodeableConcept0..*
Claim.item.detail.subDetail.programCodeCodeableConcept0..*
Claim.item.detail.subDetail.quantitySimpleQuantity0..1
Claim.item.detail.subDetail.unitPriceMoney0..1
Claim.item.detail.subDetail.factordecimal0..1
Claim.item.detail.subDetail.netMoney0..1
Claim.item.detail.subDetail.udiReference(Device)0..*
Claim.totalMoney0..1


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