MII IG Molekulares Tumorboard DE v2025

Antrag Kostenuebernahme: Claim

Inhalt

Dieses Profil beschreibt Informationen über den Antrag zur Kostenübernahme der durchgeführten Therapien des Follow-Up.

Verknüpfungen zu anderen Ressourcen

Zeitliche Zuordnung im Verlauf

Name	Status	Version	Canonical	Basis
MII_PR_MTB_Antrag_Kostenuebernahme	draft	2024.0.0-ballot	https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-antrag-kostenuebernahme	http://hl7.org/fhir/StructureDefinition/Claim

Inhalt

MII_PR_MTB_Antrag_Kostenuebernahme (Claim)	I		Claim	There are no (further) constraints on this element Element id Claim Short description Claim, Pre-determination or Pre-authorization Alternate names Adjudication Request, Preauthorization Request, Predetermination Request Definition A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement. Comments The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services. Data type Claim Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Request
id	Σ	0..1	string	There are no (further) constraints on this element Element id Claim.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	S Σ	0..1	Meta	There are no (further) constraints on this element Element id Claim.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Claim.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id Claim.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id Claim.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Claim.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier		0..*	Identifier	There are no (further) constraints on this element Element id Claim.identifier Short description Business Identifier for claim Alternate names Claim Number Definition A unique identifier assigned to this claim. Requirements Allows claims to be distinguished and referenced. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.identifier w5: FiveWs.identifier
status	S Σ ?!	1..1	codeBindingPattern	Element id Claim.status Short description Antrag Definition Status der FHIR-Ressource - statisch auf #active gesetzt Requirements Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A code specifying the state of the resource instance. FinancialResourceStatusCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern active Mappings workflow: Request.status w5: FiveWs.status
type	S Σ	1..1	CodeableConceptBinding	Element id Claim.type Short description Kategorie des Antragstellers Definition Kategorie des Antragstellers - z.B. stationär, ambulant, Apotheke Requirements Claim type determine the general sets of business rules applied for information requirements and adjudication. Comments The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements. Data type CodeableConcept Binding The type or discipline-style of the claim. MII_VS_MTB_Antrag_Kostenuebernahme (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
subType		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.subType Short description More granular claim type Definition A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. Requirements Some jurisdictions need a finer grained claim type for routing and adjudication. Comments This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. Data type CodeableConcept Binding A more granular claim typecode. ExampleClaimSubTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
use	S Σ	1..1	codeBinding	Element id Claim.use Short description Art des Kostenerstattungsantrags (claim, predetermination, preauthorization) Definition folgt den Definitionen wie im amerikanischen Gesundsheitswesen gebräuchlich. claim: Erstattungsantrag nach erfolgter Therapie; predetermination: unverbindliche Anfrage, insb. zu Anteilen der Kostenübernahme; preauthorization: Anfrage nach möglicher Erstattung für zukünftige Therapie Requirements This element is required to understand the nature of the request for adjudication. Data type code Binding The purpose of the Claim: predetermination, preauthorization, claim. Use (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
patient	S Σ	1..1	Reference(Patient)	There are no (further) constraints on this element Element id Claim.patient Short description The recipient of the products and services Definition The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought. Requirements The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction. Data type Reference(Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.subject w5: FiveWs.subject[x] w5: FiveWs.subject
billablePeriod	Σ	0..1	Period	There are no (further) constraints on this element Element id Claim.billablePeriod Short description Relevant time frame for the claim Definition The period for which charges are being submitted. Requirements A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. Comments Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
created	S Σ	1..1	dateTime	Element id Claim.created Short description Antragsdatum Definition Datum der Antragstellung Requirements Need to record a timestamp for use by both the recipient and the issuer. Comments This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.authoredOn w5: FiveWs.recorded
enterer		0..1	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id Claim.enterer Short description Author of the claim Definition Individual who created the claim, predetermination or preauthorization. Requirements Some jurisdictions require the contact information for personnel completing claims. Data type Reference(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.author
insurer	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element id Claim.insurer Short description Target Definition The Insurer who is target of the request. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.performer
provider	S Σ	1..1	Reference(Practitioner \| PractitionerRole \| Organization)	Element id Claim.provider Short description Antragstellende Einrichtung / Klinik / Person Definition Einrichtung, die den Antrag stellt. In der Regel die Klinik, die den Patienten behandelt Comments Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.requester w5: FiveWs.source
priority	S Σ	1..1	CodeableConceptPattern	Element id Claim.priority Short description Priorität des Antrags Definition Priorität des Antrags. Pflichtfeld in FHIR, aber nicht in der MII-Logik relevant Requirements The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. Comments If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request. Data type CodeableConcept Binding The timeliness with which processing is required: stat, normal, deferred. ProcessPriorityCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "coding": [ { "code": "normal" } ] } Mappings workflow: Request.priority
fundsReserve		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.fundsReserve Short description For whom to reserve funds Alternate names Fund pre-allocation Definition A code to indicate whether and for whom funds are to be reserved for future claims. Requirements In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested. Comments This field is only used for preauthorizations. Data type CodeableConcept Binding For whom funds are to be reserved: (Patient, Provider, None). Funds Reservation Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
related	S	0..*	BackboneElement	There are no (further) constraints on this element Element id Claim.related Short description Prior or corollary claims Definition Other claims which are related to this claim such as prior submissions or claims for related services or for the same event. Requirements For workplace or other accidents it is common to relate separate claims arising from the same event. Comments For example, for the original treatment and follow-up exams. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id Claim.related.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.related.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.related.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
claim	S	0..1	Reference(MII_PR_MTB_Antrag_Kostenuebernahme)	Element id Claim.related.claim Short description bei Folgeantrag/Widerspruch: Verweis auf ursprünglichen Erstantrag Definition Verweis auf ursprünglichen Erstantrag, der zu diesem Folgeantrag oder Widerspruch führt Requirements For workplace or other accidents it is common to relate separate claims arising from the same event. Data type Reference(MII_PR_MTB_Antrag_Kostenuebernahme) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.replaces
relationship	S	0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.related.relationship Short description How the reference claim is related Definition A code to convey how the claims are related. Requirements Some insurers need a declaration of the type of relationship. Comments For example, prior claim or umbrella. Data type CodeableConcept Binding Relationship of this claim to a related Claim. ExampleRelatedClaimRelationshipCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id Claim.related.relationship.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.related.relationship.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
coding	S Σ	1..*	Coding	Element id Claim.related.relationship.coding Short description Antragsstadium Definition Stadium des Antrags auf Kostenuebernahme - Erstantrag, Widerspruch, Folgeantrag, Unbekannt. Bei Widerspruch oder Folgeantrag ist der Verweis auf den Erstantrag erforderlich Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id Claim.related.relationship.coding.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.related.relationship.coding.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	Σ	0..1	uriPattern	Element id Claim.related.relationship.coding.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/CodeSystem/mii-cs-mtb-antrag-kostenuebernahme-antragsstadium Mappings v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id Claim.related.relationship.coding.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id Claim.related.relationship.coding.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id Claim.related.relationship.coding.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id Claim.related.relationship.coding.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element id Claim.related.relationship.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
reference		0..1	Identifier	There are no (further) constraints on this element Element id Claim.related.reference Short description File or case reference Definition An alternate organizational reference to the case or file to which this particular claim pertains. Requirements In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges. Comments For example, Property/Casualty insurer claim # or Workers Compensation case # . Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
prescription	S	0..1	Reference(MedicationRequest)	Element id Claim.prescription Short description Therapieempfehlung Definition Verweis auf die Therapieempfehlung des MTB, die zu diesem Antrag führt Requirements Required to authorize the dispensing of controlled substances and devices. Data type Reference(MedicationRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
originalPrescription		0..1	Reference(DeviceRequest \| MedicationRequest \| VisionPrescription)	There are no (further) constraints on this element Element id Claim.originalPrescription Short description Original prescription if superseded by fulfiller Definition Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. Requirements Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription. Comments For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'. Data type Reference(DeviceRequest \| MedicationRequest \| VisionPrescription) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
payee		0..1	BackboneElement	There are no (further) constraints on this element Element id Claim.payee Short description Recipient of benefits payable Definition The party to be reimbursed for cost of the products and services according to the terms of the policy. Requirements The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. Comments Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id Claim.payee.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.payee.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.payee.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		1..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.payee.type Short description Category of recipient Definition Type of Party to be reimbursed: subscriber, provider, other. Requirements Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. Data type CodeableConcept Binding A code for the party to be reimbursed. Claim Payee Type Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
party		0..1	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Claim.payee.party Short description Recipient reference Definition Reference to the individual or organization to whom any payment will be made. Requirements Need to provide demographics if the payee is not 'subscriber' nor 'provider'. Comments Not required if the payee is 'subscriber' or 'provider'. Data type Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
referral		0..1	Reference(ServiceRequest)	There are no (further) constraints on this element Element id Claim.referral Short description Treatment referral Definition A reference to a referral resource. Requirements Some insurers require proof of referral to pay for services or to pay specialist rates for services. Comments The referral resource which lists the date, practitioner, reason and other supporting information. Data type Reference(ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.cause
facility		0..1	Reference(Location)	There are no (further) constraints on this element Element id Claim.facility Short description Servicing facility Definition Facility where the services were provided. Requirements Insurance adjudication can be dependant on where services were delivered. Data type Reference(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.where[x]
careTeam		1..*	BackboneElement	Element id Claim.careTeam Short description Members of the care team Definition The members of the team who provided the products and services. Requirements Common to identify the responsible and supporting practitioners. Data type BackboneElement Sliced: Unordered, Open, by sequence(Type) Slice für Antragsstellung ZPM Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
(All Slices)				There are no (further) constraints on this element
id		0..1	string	There are no (further) constraints on this element Element id Claim.careTeam.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.careTeam.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.careTeam.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id Claim.careTeam.sequence Short description Order of care team Definition A number to uniquely identify care team entries. Requirements Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
provider		1..1	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id Claim.careTeam.provider Short description Practitioner or organization Definition Member of the team who provided the product or service. Requirements Often a regulatory requirement to specify the responsible provider. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.actor
responsible		0..1	boolean	There are no (further) constraints on this element Element id Claim.careTeam.responsible Short description Indicator of the lead practitioner Definition The party who is billing and/or responsible for the claimed products or services. Requirements When multiple parties are present it is required to distinguish the lead or responsible individual. Comments Responsible might not be required when there is only a single provider listed. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
role		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.careTeam.role Short description Function within the team Definition The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. Requirements When multiple parties are present it is required to distinguish the roles performed by each member. Comments Role might not be required when there is only a single provider listed. Data type CodeableConcept Binding The role codes for the care team members. ClaimCareTeamRoleCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
qualification		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.careTeam.qualification Short description Practitioner credential or specialization Definition The qualification of the practitioner which is applicable for this service. Requirements Need to specify which qualification a provider is delivering the product or service under. Data type CodeableConcept Binding Provider professional qualifications. ExampleProviderQualificationCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
ZPMBeteiligung	S	1..1	BackboneElement	Element id Claim.careTeam:ZPMBeteiligung Short description Antragstellung ZPM Definition Verweis auf entsprechendes Feld in NGS Bericht und/oder IHC (Verweis auf KDS Molekular-Pathologischer Befundbericht) Requirements Common to identify the responsible and supporting practitioners. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id Claim.careTeam:ZPMBeteiligung.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.careTeam:ZPMBeteiligung.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.careTeam:ZPMBeteiligung.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence	S	1..1	positiveIntPattern	Element id Claim.careTeam:ZPMBeteiligung.sequence Short description interne Variable der beteiligten Einrichtung Definition A number to uniquely identify care team entries. Requirements Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern 1
provider	S	1..1	Reference(Organization)	Element id Claim.careTeam:ZPMBeteiligung.provider Short description Verweis auf ZPM Definition Verweis auf Antragstellendes ZPM (z.B. ZPM ID) Requirements Often a regulatory requirement to specify the responsible provider. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.actor
responsible	S	1..1	boolean	Element id Claim.careTeam:ZPMBeteiligung.responsible Short description Beteiliung ZPM - Ja/Nein Definition Beteiliung des ZPM - Ja/Nein Requirements When multiple parties are present it is required to distinguish the lead or responsible individual. Comments Responsible might not be required when there is only a single provider listed. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
role		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.careTeam:ZPMBeteiligung.role Short description Function within the team Definition The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. Requirements When multiple parties are present it is required to distinguish the roles performed by each member. Comments Role might not be required when there is only a single provider listed. Data type CodeableConcept Binding The role codes for the care team members. ClaimCareTeamRoleCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
qualification		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.careTeam:ZPMBeteiligung.qualification Short description Practitioner credential or specialization Definition The qualification of the practitioner which is applicable for this service. Requirements Need to specify which qualification a provider is delivering the product or service under. Data type CodeableConcept Binding Provider professional qualifications. ExampleProviderQualificationCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
supportingInfo		0..*	BackboneElement	There are no (further) constraints on this element Element id Claim.supportingInfo Short description Supporting information Alternate names Attachments Exception Codes Occurrence Codes Value codes Definition Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Requirements Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Comments Often there are multiple jurisdiction specific valuesets which are required. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.supportingInfo
id		0..1	string	There are no (further) constraints on this element Element id Claim.supportingInfo.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.supportingInfo.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.supportingInfo.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id Claim.supportingInfo.sequence Short description Information instance identifier Definition A number to uniquely identify supporting information entries. Requirements Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.supportingInfo.category Short description Classification of the supplied information Definition The general class of the information supplied: information; exception; accident, employment; onset, etc. Requirements Required to group or associate information items with common characteristics. For example: admission information or prior treatments. Comments This may contain a category for the local bill type codes. Data type CodeableConcept Binding The valuset used for additional information category codes. ClaimInformationCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
code		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.supportingInfo.code Short description Type of information Definition System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Requirements Required to identify the kind of additional information. Data type CodeableConcept Binding The valuset used for additional information codes. ExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
timing[x]		0..1		There are no (further) constraints on this element Element id Claim.supportingInfo.timing[x] Short description When it occurred Definition The date when or period to which this information refers. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
timingDate			date	There are no (further) constraints on this element Data type date
timingPeriod			Period	There are no (further) constraints on this element Data type Period
value[x]		0..1		There are no (further) constraints on this element Element id Claim.supportingInfo.value[x] Short description Data to be provided Definition Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. Requirements To convey the data content to be provided when the information is more than a simple code or period. Comments Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
valueString			string	There are no (further) constraints on this element Data type string
valueQuantity			Quantity	There are no (further) constraints on this element Data type Quantity
valueAttachment			Attachment	There are no (further) constraints on this element Data type Attachment
valueReference			Reference(Resource)	There are no (further) constraints on this element Data type Reference(Resource)
reason		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.supportingInfo.reason Short description Explanation for the information Definition Provides the reason in the situation where a reason code is required in addition to the content. Requirements Needed when the supporting information has both a date and amount/value and requires explanation. Comments For example: the reason for the additional stay, or why a tooth is missing. Data type CodeableConcept Binding Reason codes for the missing teeth. MissingToothReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosis		0..*	BackboneElement	There are no (further) constraints on this element Element id Claim.diagnosis Short description Pertinent diagnosis information Definition Information about diagnoses relevant to the claim items. Requirements Required for the adjudication by provided context for the services and product listed. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.reasonReference
id		0..1	string	There are no (further) constraints on this element Element id Claim.diagnosis.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.diagnosis.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.diagnosis.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id Claim.diagnosis.sequence Short description Diagnosis instance identifier Definition A number to uniquely identify diagnosis entries. Requirements Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. Comments Diagnosis are presented in list order to their expected importance: primary, secondary, etc. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosis[x]		1..1		There are no (further) constraints on this element Element id Claim.diagnosis.diagnosis[x] Short description Nature of illness or problem Definition The nature of illness or problem in a coded form or as a reference to an external defined Condition. Requirements Provides health context for the evaluation of the products and/or services. Binding Example ICD10 Diagnostic codes. ICD-10Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosisCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
diagnosisReference			Reference(Condition)	There are no (further) constraints on this element Data type Reference(Condition)
type		0..*	CodeableConcept	There are no (further) constraints on this element Element id Claim.diagnosis.type Short description Timing or nature of the diagnosis Definition When the condition was observed or the relative ranking. Requirements Often required to capture a particular diagnosis, for example: primary or discharge. Comments For example: admitting, primary, secondary, discharge. Data type CodeableConcept Binding The type of the diagnosis: admitting, principal, discharge. ExampleDiagnosisTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
onAdmission		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.diagnosis.onAdmission Short description Present on admission Definition Indication of whether the diagnosis was present on admission to a facility. Requirements Many systems need to understand for adjudication if the diagnosis was present a time of admission. Data type CodeableConcept Binding Present on admission. ExampleDiagnosisOnAdmissionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
packageCode		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.diagnosis.packageCode Short description Package billing code Definition A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. Requirements Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. Comments For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. Data type CodeableConcept Binding The DRG codes associated with the diagnosis. ExampleDiagnosisRelatedGroupCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedure		0..*	BackboneElement	There are no (further) constraints on this element Element id Claim.procedure Short description Clinical procedures performed Definition Procedures performed on the patient relevant to the billing items with the claim. Requirements The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id Claim.procedure.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.procedure.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.procedure.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id Claim.procedure.sequence Short description Procedure instance identifier Definition A number to uniquely identify procedure entries. Requirements Necessary to provide a mechanism to link to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..*	CodeableConcept	There are no (further) constraints on this element Element id Claim.procedure.type Short description Category of Procedure Definition When the condition was observed or the relative ranking. Requirements Often required to capture a particular diagnosis, for example: primary or discharge. Comments For example: primary, secondary. Data type CodeableConcept Binding Example procedure type codes. ExampleProcedureTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
date		0..1	dateTime	There are no (further) constraints on this element Element id Claim.procedure.date Short description When the procedure was performed Definition Date and optionally time the procedure was performed. Requirements Required for auditing purposes. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedure[x]		1..1		There are no (further) constraints on this element Element id Claim.procedure.procedure[x] Short description Specific clinical procedure Definition The code or reference to a Procedure resource which identifies the clinical intervention performed. Requirements This identifies the actual clinical procedure. Binding Example ICD10 Procedure codes. ICD-10ProcedureCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedureCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
procedureReference			Reference(Procedure)	There are no (further) constraints on this element Data type Reference(Procedure)
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id Claim.procedure.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
insurance	S Σ	1..*	BackboneElement	There are no (further) constraints on this element Element id Claim.insurance Short description Patient insurance information Definition Financial instruments for reimbursement for the health care products and services specified on the claim. Requirements At least one insurer is required for a claim to be a claim. Comments All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Coverage
id		0..1	string	There are no (further) constraints on this element Element id Claim.insurance.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.insurance.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.insurance.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence	S Σ	1..1	positiveIntPattern	Element id Claim.insurance.sequence Short description Insurance instance identifier Definition A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order. Requirements To maintain order of the coverages. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern 1
focal	S Σ	1..1	booleanPattern	Element id Claim.insurance.focal Short description Coverage to be used for adjudication Definition A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. Requirements To identify which coverage in the list is being used to adjudicate this claim. Comments A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern true
identifier		0..1	Identifier	There are no (further) constraints on this element Element id Claim.insurance.identifier Short description Pre-assigned Claim number Definition The business identifier to be used when the claim is sent for adjudication against this insurance policy. Requirements This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication. Comments Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.identifier w5: FiveWs.identifier
coverage	S Σ	1..1	Reference(Coverage)	There are no (further) constraints on this element Element id Claim.insurance.coverage Short description Insurance information Definition Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. Requirements Required to allow the adjudicator to locate the correct policy and history within their information system. Data type Reference(Coverage) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
businessArrangement		0..1	string	There are no (further) constraints on this element Element id Claim.insurance.businessArrangement Short description Additional provider contract number Definition A business agreement number established between the provider and the insurer for special business processing purposes. Requirements Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRef		0..*	string	There are no (further) constraints on this element Element id Claim.insurance.preAuthRef Short description Prior authorization reference number Definition Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. Requirements Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. Comments This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
claimResponse	S	0..1	Reference(ClaimResponse)	There are no (further) constraints on this element Element id Claim.insurance.claimResponse Short description Adjudication results Definition The result of the adjudication of the line items for the Coverage specified in this insurance. Requirements An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim. Comments Must not be specified when 'focal=true' for this insurance. Data type Reference(ClaimResponse) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
accident		0..1	BackboneElement	There are no (further) constraints on this element Element id Claim.accident Short description Details of the event Definition Details of an accident which resulted in injuries which required the products and services listed in the claim. Requirements When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id Claim.accident.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.accident.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.accident.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
date		1..1	date	There are no (further) constraints on this element Element id Claim.accident.date Short description When the incident occurred Definition Date of an accident event related to the products and services contained in the claim. Requirements Required for audit purposes and adjudication. Comments The date of the accident has to precede the dates of the products and services but within a reasonable timeframe. Data type date Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Claim.accident.type Short description The nature of the accident Definition The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. Requirements Coverage may be dependant on the type of accident. Data type CodeableConcept Binding Type of accident: work place, auto, etc. v3.ActIncidentCode (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
location[x]		0..1		There are no (further) constraints on this element Element id Claim.accident.location[x] Short description Where the event occurred Definition The physical location of the accident event. Requirements Required for audit purposes and determination of applicable insurance liability. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
item		0..*	BackboneElement	There are no (further) constraints on this element Element id Claim.item Short description Product or service provided Definition A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details. Requirements The items to be processed for adjudication. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id Claim.item.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.item.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.item.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id Claim.item.sequence Short description Item instance identifier Definition A number to uniquely identify item entries. Requirements Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
careTeamSequence		0..*	positiveInt	There are no (further) constraints on this element Element id Claim.item.careTeamSequence Short description Applicable careTeam members Definition CareTeam members related to this service or product. Requirements Need to identify the individuals and their roles in the provision of the product or service. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosisSequence		0..*	positiveInt	There are no (further) constraints on this element Element id Claim.item.diagnosisSequence Short description Applicable diagnoses Definition Diagnosis applicable for this service or product. Requirements Need to related the product or service to the associated diagnoses. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedureSequence		0..*	positiveInt	There are no (further) constraints on this element Element id Claim.item.procedureSequence Short description Applicable procedures Definition Procedures applicable for this service or product. Requirements Need to provide any listed specific procedures to support the product or service being claimed. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
informationSequence		0..*	positiveInt	There are no (further) constraints on this element Element id Claim.item.informationSequence Short description Applicable exception and supporting information Definition Exceptions, special conditions and supporting information applicable for this service or product. Requirements Need to reference the supporting information items that relate directly to this product or service. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral-basic, major, glasses. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.modifier Short description Product or service billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
serviced[x]		0..1		There are no (further) constraints on this element Element id Claim.item.serviced[x] Short description Date or dates of service or product delivery Definition The date or dates when the service or product was supplied, performed or completed. Requirements Needed to determine whether the service or product was provided during the term of the insurance coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
servicedDate			date	There are no (further) constraints on this element Data type date
servicedPeriod			Period	There are no (further) constraints on this element Data type Period
location[x]		0..1		There are no (further) constraints on this element Element id Claim.item.location[x] Short description Place of service or where product was supplied Definition Where the product or service was provided. Requirements The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Binding Place of service: pharmacy, school, prison, etc. ExampleServicePlaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.where[x]
locationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id Claim.item.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id Claim.item.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id Claim.item.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id Claim.item.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id Claim.item.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
bodySite		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.bodySite Short description Anatomical location Definition Physical service site on the patient (limb, tooth, etc.). Requirements Allows insurer to validate specific procedures. Comments For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed. Data type CodeableConcept Binding The code for the teeth, quadrant, sextant and arch. OralSiteCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subSite		0..*	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.subSite Short description Anatomical sub-location Definition A region or surface of the bodySite, e.g. limb region or tooth surface(s). Requirements Allows insurer to validate specific procedures. Data type CodeableConcept Binding The code for the tooth surface and surface combinations. SurfaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
encounter		0..*	Reference(Encounter)	There are no (further) constraints on this element Element id Claim.item.encounter Short description Encounters related to this billed item Definition The Encounters during which this Claim was created or to which the creation of this record is tightly associated. Requirements Used in some jurisdictions to link clinical events to claim items. Comments This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.context
detail		0..*	BackboneElement	There are no (further) constraints on this element Element id Claim.item.detail Short description Product or service provided Definition A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. Requirements The items to be processed for adjudication. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id Claim.item.detail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.item.detail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.item.detail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id Claim.item.detail.sequence Short description Item instance identifier Definition A number to uniquely identify item entries. Requirements Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral-basic, major, glasses. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id Claim.item.detail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id Claim.item.detail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id Claim.item.detail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id Claim.item.detail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id Claim.item.detail.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetail		0..*	BackboneElement	There are no (further) constraints on this element Element id Claim.item.detail.subDetail Short description Product or service provided Definition A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. Requirements The items to be processed for adjudication. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.sequence Short description Item instance identifier Definition A number to uniquely identify item entries. Requirements Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral-basic, major, glasses. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.productOrService Short description Billing, service, product, or drug code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id Claim.item.detail.subDetail.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
total		0..1	Money	There are no (further) constraints on this element Element id Claim.total Short description Total claim cost Definition The total value of the all the items in the claim. Requirements Used for control total purposes. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`

Antrag Kostenübernahme

Feldname	Kurzbeschreibung
Claim.meta
Claim.status	Antrag
Claim.type	Kategorie des Antragstellers
Claim.use	Art des Kostenerstattungsantrags (claim, predetermination, preauthorization)
Claim.patient
Claim.created	Antragsdatum
Claim.provider	Antragstellende Einrichtung / Klinik / Person
Claim.priority	Priorität des Antrags
Claim.related
Claim.related.claim	bei Folgeantrag/Widerspruch: Verweis auf ursprünglichen Erstantrag
Claim.related.relationship
Claim.related.relationship.coding	Antragsstadium
Claim.related.relationship.coding.code
Claim.prescription	Therapieempfehlung
Claim.careTeam:ZPMBeteiligung	Antragstellung ZPM
Claim.careTeam:ZPMBeteiligung.sequence	interne Variable der beteiligten Einrichtung
Claim.careTeam:ZPMBeteiligung.provider	Verweis auf ZPM
Claim.careTeam:ZPMBeteiligung.responsible	Beteiliung ZPM - Ja/Nein
Claim.insurance
Claim.insurance.sequence
Claim.insurance.focal
Claim.insurance.coverage
Claim.insurance.claimResponse

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="mii-pr-mtb-antrag-kostenuebernahme" />
    <url value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-antrag-kostenuebernahme" />
    <version value="2024.0.0-ballot" />
    <name value="MII_PR_MTB_Antrag_Kostenuebernahme" />
    <title value="MII PR MTB Antrag Kostenuebernahme" />
    <status value="draft" />
    <publisher value="Medizininformatik Initiative" />
    <contact>
        <telecom>
            <system value="url" />
            <value value="https://www.medizininformatik-initiative.de" />
        </telecom>
    </contact>
    <description value="Antrag Kosten&#252;bernahme" />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Claim" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Claim" />
    <derivation value="constraint" />
    <differential>
        <element id="Claim.meta">
            <path value="Claim.meta" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.status">
            <path value="Claim.status" />
            <short value="Antrag" />
            <definition value="Status der FHIR-Ressource - statisch auf #active gesetzt" />
            <patternCode value="active" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.type">
            <path value="Claim.type" />
            <short value="Kategorie des Antragstellers" />
            <definition value="Kategorie des Antragstellers - z.B. station&#228;r, ambulant, Apotheke" />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/ValueSet/mii-vs-mtb-antrag-kostenuebernahme" />
            </binding>
        </element>
        <element id="Claim.use">
            <path value="Claim.use" />
            <short value="Art des Kostenerstattungsantrags (claim, predetermination, preauthorization)" />
            <definition value="folgt den Definitionen wie im amerikanischen Gesundsheitswesen gebr&#228;uchlich. claim: Erstattungsantrag nach erfolgter Therapie; predetermination: unverbindliche Anfrage, insb. zu Anteilen der Kosten&#252;bernahme;  preauthorization: Anfrage nach m&#246;glicher Erstattung f&#252;r zuk&#252;nftige Therapie" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.patient">
            <path value="Claim.patient" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.created">
            <path value="Claim.created" />
            <short value="Antragsdatum" />
            <definition value="Datum der Antragstellung" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.provider">
            <path value="Claim.provider" />
            <short value="Antragstellende Einrichtung / Klinik / Person" />
            <definition value="Einrichtung, die den Antrag stellt. In der Regel die Klinik, die den Patienten behandelt" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.priority">
            <path value="Claim.priority" />
            <short value="Priorit&#228;t des Antrags" />
            <definition value="Priorit&#228;t des Antrags. Pflichtfeld in FHIR, aber nicht in der MII-Logik relevant" />
            <patternCodeableConcept>
                <coding>
                    <code value="normal" />
                </coding>
            </patternCodeableConcept>
            <mustSupport value="true" />
        </element>
        <element id="Claim.related">
            <path value="Claim.related" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.related.claim">
            <path value="Claim.related.claim" />
            <short value="bei Folgeantrag/Widerspruch: Verweis auf urspr&#252;nglichen Erstantrag" />
            <definition value="Verweis auf urspr&#252;nglichen Erstantrag, der zu diesem Folgeantrag oder Widerspruch f&#252;hrt" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-antrag-kostenuebernahme" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="Claim.related.relationship">
            <path value="Claim.related.relationship" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.related.relationship.coding">
            <path value="Claim.related.relationship.coding" />
            <short value="Antragsstadium" />
            <definition value="Stadium des Antrags auf Kostenuebernahme - Erstantrag, Widerspruch, Folgeantrag, Unbekannt. Bei Widerspruch oder Folgeantrag ist der Verweis auf den Erstantrag erforderlich" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.related.relationship.coding.system">
            <path value="Claim.related.relationship.coding.system" />
            <patternUri value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/CodeSystem/mii-cs-mtb-antrag-kostenuebernahme-antragsstadium" />
        </element>
        <element id="Claim.related.relationship.coding.code">
            <path value="Claim.related.relationship.coding.code" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.prescription">
            <path value="Claim.prescription" />
            <short value="Therapieempfehlung" />
            <definition value="Verweis auf die Therapieempfehlung des MTB, die zu diesem Antrag f&#252;hrt" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="Claim.careTeam">
            <path value="Claim.careTeam" />
            <slicing>
                <discriminator>
                    <type value="type" />
                    <path value="sequence" />
                </discriminator>
                <description value="Slice f&#252;r Antragsstellung ZPM" />
                <ordered value="false" />
                <rules value="open" />
            </slicing>
            <min value="1" />
        </element>
        <element id="Claim.careTeam:ZPMBeteiligung">
            <path value="Claim.careTeam" />
            <sliceName value="ZPMBeteiligung" />
            <short value="Antragstellung ZPM" />
            <definition value="Verweis auf entsprechendes Feld in NGS Bericht und/oder IHC (Verweis auf KDS Molekular-Pathologischer Befundbericht)" />
            <min value="1" />
            <max value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.careTeam:ZPMBeteiligung.sequence">
            <path value="Claim.careTeam.sequence" />
            <short value="interne Variable der beteiligten Einrichtung" />
            <patternPositiveInt value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.careTeam:ZPMBeteiligung.provider">
            <path value="Claim.careTeam.provider" />
            <short value="Verweis auf ZPM" />
            <definition value="Verweis auf Antragstellendes ZPM (z.B. ZPM ID)" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="Claim.careTeam:ZPMBeteiligung.responsible">
            <path value="Claim.careTeam.responsible" />
            <short value="Beteiliung ZPM - Ja/Nein" />
            <definition value="Beteiliung des ZPM - Ja/Nein" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.insurance">
            <path value="Claim.insurance" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.insurance.sequence">
            <path value="Claim.insurance.sequence" />
            <patternPositiveInt value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.insurance.focal">
            <path value="Claim.insurance.focal" />
            <patternBoolean value="true" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.insurance.coverage">
            <path value="Claim.insurance.coverage" />
            <mustSupport value="true" />
        </element>
        <element id="Claim.insurance.claimResponse">
            <path value="Claim.insurance.claimResponse" />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "mii-pr-mtb-antrag-kostenuebernahme",
    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-antrag-kostenuebernahme",
    "version": "2024.0.0-ballot",
    "name": "MII_PR_MTB_Antrag_Kostenuebernahme",
    "title": "MII PR MTB Antrag Kostenuebernahme",
    "status": "draft",
    "publisher": "Medizininformatik Initiative",
    "contact":  [
        {
            "telecom":  [
                {
                    "system": "url",
                    "value": "https://www.medizininformatik-initiative.de"
                }
            ]
        }
    ],
    "description": "Antrag Kostenübernahme",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Claim",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Claim",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Claim.meta",
                "path": "Claim.meta",
                "mustSupport": true
            },
            {
                "id": "Claim.status",
                "path": "Claim.status",
                "short": "Antrag",
                "definition": "Status der FHIR-Ressource - statisch auf #active gesetzt",
                "patternCode": "active",
                "mustSupport": true
            },
            {
                "id": "Claim.type",
                "path": "Claim.type",
                "short": "Kategorie des Antragstellers",
                "definition": "Kategorie des Antragstellers - z.B. stationär, ambulant, Apotheke",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/ValueSet/mii-vs-mtb-antrag-kostenuebernahme"
                }
            },
            {
                "id": "Claim.use",
                "path": "Claim.use",
                "short": "Art des Kostenerstattungsantrags (claim, predetermination, preauthorization)",
                "definition": "folgt den Definitionen wie im amerikanischen Gesundsheitswesen gebräuchlich. claim: Erstattungsantrag nach erfolgter Therapie; predetermination: unverbindliche Anfrage, insb. zu Anteilen der Kostenübernahme;  preauthorization: Anfrage nach möglicher Erstattung für zukünftige Therapie",
                "mustSupport": true
            },
            {
                "id": "Claim.patient",
                "path": "Claim.patient",
                "mustSupport": true
            },
            {
                "id": "Claim.created",
                "path": "Claim.created",
                "short": "Antragsdatum",
                "definition": "Datum der Antragstellung",
                "mustSupport": true
            },
            {
                "id": "Claim.provider",
                "path": "Claim.provider",
                "short": "Antragstellende Einrichtung / Klinik / Person",
                "definition": "Einrichtung, die den Antrag stellt. In der Regel die Klinik, die den Patienten behandelt",
                "mustSupport": true
            },
            {
                "id": "Claim.priority",
                "path": "Claim.priority",
                "short": "Priorität des Antrags",
                "definition": "Priorität des Antrags. Pflichtfeld in FHIR, aber nicht in der MII-Logik relevant",
                "patternCodeableConcept": {
                    "coding":  [
                        {
                            "code": "normal"
                        }
                    ]
                },
                "mustSupport": true
            },
            {
                "id": "Claim.related",
                "path": "Claim.related",
                "mustSupport": true
            },
            {
                "id": "Claim.related.claim",
                "path": "Claim.related.claim",
                "short": "bei Folgeantrag/Widerspruch: Verweis auf ursprünglichen Erstantrag",
                "definition": "Verweis auf ursprünglichen Erstantrag, der zu diesem Folgeantrag oder Widerspruch führt",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-antrag-kostenuebernahme"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "Claim.related.relationship",
                "path": "Claim.related.relationship",
                "mustSupport": true
            },
            {
                "id": "Claim.related.relationship.coding",
                "path": "Claim.related.relationship.coding",
                "short": "Antragsstadium",
                "definition": "Stadium des Antrags auf Kostenuebernahme - Erstantrag, Widerspruch, Folgeantrag, Unbekannt. Bei Widerspruch oder Folgeantrag ist der Verweis auf den Erstantrag erforderlich",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Claim.related.relationship.coding.system",
                "path": "Claim.related.relationship.coding.system",
                "patternUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/CodeSystem/mii-cs-mtb-antrag-kostenuebernahme-antragsstadium"
            },
            {
                "id": "Claim.related.relationship.coding.code",
                "path": "Claim.related.relationship.coding.code",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Claim.prescription",
                "path": "Claim.prescription",
                "short": "Therapieempfehlung",
                "definition": "Verweis auf die Therapieempfehlung des MTB, die zu diesem Antrag führt",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/MedicationRequest"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "Claim.careTeam",
                "path": "Claim.careTeam",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "type",
                            "path": "sequence"
                        }
                    ],
                    "rules": "open",
                    "description": "Slice für Antragsstellung ZPM",
                    "ordered": false
                },
                "min": 1
            },
            {
                "id": "Claim.careTeam:ZPMBeteiligung",
                "path": "Claim.careTeam",
                "sliceName": "ZPMBeteiligung",
                "short": "Antragstellung ZPM",
                "definition": "Verweis auf entsprechendes Feld in NGS Bericht und/oder IHC (Verweis auf KDS Molekular-Pathologischer Befundbericht)",
                "min": 1,
                "max": "1",
                "mustSupport": true
            },
            {
                "id": "Claim.careTeam:ZPMBeteiligung.sequence",
                "path": "Claim.careTeam.sequence",
                "short": "interne Variable der beteiligten Einrichtung",
                "patternPositiveInt": 1,
                "mustSupport": true
            },
            {
                "id": "Claim.careTeam:ZPMBeteiligung.provider",
                "path": "Claim.careTeam.provider",
                "short": "Verweis auf ZPM",
                "definition": "Verweis auf Antragstellendes ZPM (z.B. ZPM ID)",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/Organization"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "Claim.careTeam:ZPMBeteiligung.responsible",
                "path": "Claim.careTeam.responsible",
                "short": "Beteiliung ZPM - Ja/Nein",
                "definition": "Beteiliung des ZPM - Ja/Nein",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Claim.insurance",
                "path": "Claim.insurance",
                "mustSupport": true
            },
            {
                "id": "Claim.insurance.sequence",
                "path": "Claim.insurance.sequence",
                "patternPositiveInt": 1,
                "mustSupport": true
            },
            {
                "id": "Claim.insurance.focal",
                "path": "Claim.insurance.focal",
                "patternBoolean": true,
                "mustSupport": true
            },
            {
                "id": "Claim.insurance.coverage",
                "path": "Claim.insurance.coverage",
                "mustSupport": true
            },
            {
                "id": "Claim.insurance.claimResponse",
                "path": "Claim.insurance.claimResponse",
                "mustSupport": true
            }
        ]
    }
}

MII PR MTB Antrag Kostenuebernahme

Mapping Datensatz zu FHIR

Datensatz	Erklaerung	FHIR
Ausstellungsdatum	Ausstellungsdatum Antrag Kostenübernahme	Claim.created
Therapie Empfehlung	Referenz MTB Empfehlung	Claim.prescription
Antragsstadium	Antragsstadium	Claim.related.relationship.coding
Antragssteller ZPM Geschäftsstelle	Antragssteller ZPM Geschäftsstelle	Claim.careTeam[ZPMBeteiligung].responsible

Suchparameter

Folgende Suchparameter sind für das Modul Onkologie relevant, auch in Kombination:

Der Suchparameter "_id" MUSS unterstützt werden:

Beispiele:

GET [base]/CarePlan?_id=12345

Anwendungshinweise: Weitere Informationen zur Suche nach "_id" finden sich in der FHIR-Basisspezifikation - Abschnitt "Parameters for all resources".

Beispiele