NHS Digital FHIR Medicines

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

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

replacementOf

S I

0..1

Element Id

Claim.extension:replacementOf

Short description

Used to reference a previous Claim

Alternate names

extensions, user content

Definition

Used for replacement Claims, this should reference the Claim.identifier of the Claim being replaced.


  "extension":  [
        {
            "url": "https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf",
            "valueIdentifier": {
                "value": "46055273-3001-41bd-86a0-f8dba7f2161a"
            }
        }
    ],

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf

Extension 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
rim:N/A

agent

S I

0..1

Extension(Reference(NHSDigitalPractitionerRole | NHSDigitalPractitioner | NHSDigitalHealthcareService))

Element Id

Claim.extension:agent

Short description

Provenance of the resource

Alternate names

extensions, user content

Definition

The person submitting/authoring the Claim


   "extension":  [
        {
            "url": "https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent",
            "valueReference": {
                "identifier": {
                    "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
                    "value": "884562163557"
                },
                "display": "dummy full name"
            }
        }
    ],

Comments

Data Type

Extension(Reference(NHSDigitalPractitionerRole | NHSDigitalPractitioner | NHSDigitalHealthcareService))

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent

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
rim:N/A

supplyHeaderIdentifier

S I

0..1

Element Id

Claim.extension:supplyHeaderIdentifier

Short description

Identifier for the SupplyHeader

Alternate names

extensions, user content

Definition

Identifier of the SupplyHeader (v3) object. The prescription in the context of a Dispense Notification or Claim. Mandatory for EPS interactions.

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-SupplyHeaderIdentifier

Extension 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
rim:N/A

identifier

1..*

Element Id

Claim.identifier

Short description

Business Identifier for claim

Alternate names

Claim Number

Definition

MUST be unique for each Claim. In EPS this must be a UUID with a system of https://fhir.nhs.uk/Id/prescription-dispense-item-number


      "identifier":  [
          {
              "system": "https://fhir.nhs.uk/Id/prescription-dispense-item-number",
              "value": "4509B70D-D8B8-EA03-1105-64557CB54A29"
          }
      ],

Requirements

Allows claims to be distinguished and referenced.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
workflow:Request.identifier
w5:FiveWs.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

There are no (further) constraints on this element

Element Id

Claim.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

status

S Σ ?!

1..1

codeBinding

Element Id

Claim.status

Short description

active | cancelled | draft | entered-in-error

Definition

For EPS the following MUST be used.


      "status": "active",
      "type": {
          "coding":  [
              {
                   "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy",
                    "display": "Pharmacy"
             }             
          ]
      },
      "use": "claim",

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

FinancialResourceStatusCodes (required)

Binding

A code specifying the state of the resource instance.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
workflow:Request.status
w5:FiveWs.status

type

S Σ

1..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.type

Short description

Category or discipline

Definition

The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

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

Binding

The type or discipline-style of the claim.

ClaimTypeCodes (extensible)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
w5:FiveWs.class

coding

1..*

There are no (further) constraints on this element

Element Id

Claim.type.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.type.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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

http://terminology.hl7.org/CodeSystem/claim-type

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.type.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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

codeFixed Value

Element Id

Claim.type.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

pharmacy

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.type.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.type.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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.type.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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

subType

0..1

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

ExampleClaimSubTypeCodes (example)

Binding

A more granular claim typecode.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
w5:FiveWs.class

use

1..1

codeBindingFixed Value

Element Id

Claim.use

Short description

claim | preauthorization | predetermination

Definition

A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

Requirements

This element is required to understand the nature of the request for adjudication.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

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())

Fixed Value

claim

Mappings

rim:n/a
w5:FiveWs.class

patient

S Σ I

1..1

Element Id

Claim.patient

Short description

The recipient of the products and services

Definition

MUST be an identifier reference using the Patients NHS Number.


      "patient": {
          "identifier": {
              "system": "https://fhir.nhs.uk/Id/nhs-number",
              "value": "2300992742"
          }
      },

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.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
patient-reference:An identifier reference or resource reference must be provided
(reference.exists() or identifier.exists())
patient-nhs:Length of the supplied NHS Number is wrong.
identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists().not() or (identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists() and identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').value.matches('^([0-9]{10})$'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.subject
w5:FiveWs.subject[x]
w5:FiveWs.subject

reference

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.patient.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.patient.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

1..1

There are no (further) constraints on this element

Element Id

Claim.patient.identifier

Short description

Logical reference, when literal reference is not known

Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

uriFixed Value

Element Id

Claim.patient.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/Id/nhs-number

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.patient.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

billablePeriod

Σ I

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
w5:FiveWs.done[x]

created

S Σ

1..1

Element Id

Claim.created

Short description

Resource creation date

Definition

The date of the Claim


  "created": "2004-09-16T16:30:00+00:00",

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
workflow:Request.authoredOn
w5:FiveWs.recorded

enterer

0..1

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5:FiveWs.author

insurer

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.insurer

Short description

Target

Definition

The Insurer who is target of the request.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.performer

provider

S Σ I

1..1

Element Id

Claim.provider

Short description

Party responsible for the claim

Definition

The organisation responsible for the claim, this must be a reference to a contained PractitoinerRole

 "provider": {
        "reference" : "#provider"
    },

The contained PractitionerRole

{
    "resourceType": "Claim",
    "id": "258E153F-567B-4D60-B045-BA315A6B8DB0",
    "contained": [
  {
      "resourceType": "PractitionerRole",
      "id": "provider",
      "identifier": [
        {
          "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
          "value": "454567759542"
        }
      ],
      "code": [
        {
          "coding": [
            {
              "system": "https://fhir.nhs.uk/CodeSystem/NHSDigital-SDS-JobRoleCode",
              "code": "S0030:G0100:R0620"
            }
          ]
        }
      ],
      "practitioner": {
        "identifier": {
          "system": "https://fhir.nhs.uk/Id/sds-user-id",
          "value": "7654321"
        },
        "display": "Mr Peter Potion"
      },
      "organization": {
        "reference": "#organisation"
      },
      "telecom": [
        {
          "system": "phone",
          "use": "work",
          "value": "01234567890"
        }
      ]
    },
    {
      "resourceType": "Organization",
      "id": "organisation",
      "identifier": [
        {
          "system": "https://fhir.nhs.uk/Id/ods-organization-code",
          "value": "VNE51"
        }
      ],
      "address": [
        {
          "city": "West Yorkshire",
          "use": "work",
          "line": [
            "17 Austhorpe Road",
            "Crossgates",
            "Leeds"
          ],
          "postalCode": "LS15 8BA"
        }
      ],
      "active": true,
      "type": [
        {
          "coding": [
            {
              "system": "https://fhir.nhs.uk/CodeSystem/organisation-role",
              "code": "182",
              "display": "PHARMACY"
            }
          ]
        }
      ],
      "name": "The Simple Pharmacy",
      "telecom": [
        {
          "system": "phone",
          "use": "work",
          "value": "0113 3180277"
        }
      ]
    }        
    ],

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

Allowed aggregation: contained

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.requester
w5:FiveWs.source

reference

Σ I

1..1

There are no (further) constraints on this element

Element Id

Claim.provider.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.provider.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

0..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.provider.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

priority

S Σ

1..1

Element Id

Claim.priority

Short description

Desired processing ugency

Definition

Desired processing ugency. Fixed value.

"priority": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/processpriority",
                "code": "normal"
            }
        ]
    }

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

ProcessPriorityCodes (example)

Binding

The timeliness with which processing is required: stat, normal, deferred.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow:Request.priority

coding

1..1

There are no (further) constraints on this element

Element Id

Claim.priority.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.priority.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

http://terminology.hl7.org/CodeSystem/processpriority

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.priority.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

codeFixed Value

Element Id

Claim.priority.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

normal

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.priority.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.priority.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.priority.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

fundsReserve

0..1

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

Funds Reservation Codes (example)

Binding

For whom funds are to be reserved: (Patient, Provider, None).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

claim

0..1

There are no (further) constraints on this element

Element Id

Claim.related.claim

Short description

Reference to the related claim

Definition

Reference to a related claim.

Requirements

For workplace or other accidents it is common to relate separate claims arising from the same event.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.replaces

relationship

0..1

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

Binding

Relationship of this claim to a related Claim.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

reference

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier

prescription

S I

1..1

Reference(DeviceRequest | MedicationRequest | VisionPrescription)

Element Id

Claim.prescription

Short description

Prescription authorizing services and products

Definition

References to the original prescription, the groupIdentifier contains both the ShortForm prescription id and long form UUID variant. See NHSDigital-MedicationRequest for more details.

This MUST not be used to reference the MedicationRequest.


"prescription": {
    "extension": [
        {
            "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier",
            "extension": [
                {
                    "url": "shortForm",
                    "valueIdentifier": {
                        "system": "https://fhir.nhs.uk/Id/prescription-order-number",
                        "value": "82D996-C81010-11DB12"
                    }
                },
                {
                    "url": "UUID",
                    "valueIdentifier": {
                        "system": "https://fhir.nhs.uk/Id/prescription",
                        "value": "b2fc79f0-2793-4736-9b2d-0976c21e73a5"
                    }
                }
            ]
        }
    ]
},

Requirements

Required to authorize the dispensing of controlled substances and devices.

Comments

Data Type

Reference(DeviceRequest | MedicationRequest | VisionPrescription)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

extension

1..*

Element Id

Claim.prescription.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

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

groupIdentifier

1..1

Extension(Complex)

Element Id

Claim.prescription.extension:groupIdentifier

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

Extension(Complex)

Extension 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
rim:N/A

reference

Σ I

0..0

There are no (further) constraints on this element

Element Id

Claim.prescription.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.prescription.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

0..0

There are no (further) constraints on this element

Element Id

Claim.prescription.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

display

0..1

There are no (further) constraints on this element

Element Id

Claim.prescription.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

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())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

extension

1..*

Element Id

Claim.originalPrescription.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

groupIdentifier

1..1

Extension(Complex)

Element Id

Claim.originalPrescription.extension:groupIdentifier

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

Extension(Complex)

Extension 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
rim:N/A

reference

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

payee

1..1

Element Id

Claim.payee

Short description

Recipient of benefits payable

Definition

The recipient of benefits payable. This is the ODS Code of the Pharmacy (provider) making the Claim.

See provider for example of a contained Organization.


"payee": {
    "type": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                "value": "provider",
                "display": "Provider"
            }
        ]
    },
    "party": {
        "reference": "#organisation",
        "display": "The Simple Pharmacy"
    }
}

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

type

1..1

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.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Data Type

Claim Payee Type Codes (example)

Binding

A code for the party to be reimbursed.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

1..*

There are no (further) constraints on this element

Element Id

Claim.payee.type.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.payee.type.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

http://terminology.hl7.org/CodeSystem/payeetype

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.type.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

codeFixed Value

Element Id

Claim.payee.type.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

provider

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

1..1

stringFixed Value

Element Id

Claim.payee.type.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

Provider

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.type.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.type.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

party

1..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
nhsd-claim-party:party - An identifier reference or resource reference must be provided
(reference.exists() or (identifier.exists()))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

reference

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.payee.party.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

uriFixed Value

Element Id

Claim.payee.party.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/Id/ods-organization-code

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

referral

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5:FiveWs.cause

facility

0..1

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5:FiveWs.where[x]

careTeam

0..*

There are no (further) constraints on this element

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

sequence

1..1

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

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.

Comments

Data Type

Reference(Practitioner | PractitionerRole | Organization)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5:FiveWs.actor

responsible

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

role

0..1

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

ClaimCareTeamRoleCodes (example)

Binding

The role codes for the care team members.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

qualification

0..1

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.

Comments

Data Type

ExampleProviderQualificationCodes (example)

Binding

Provider professional qualifications.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

supportingInfo

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
workflow:Request.supportingInfo

sequence

1..1

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

category

1..1

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

ClaimInformationCategoryCodes (example)

Binding

The valuset used for additional information category codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

code

0..1

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.

Comments

Data Type

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())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

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())

Mappings

rim:n/a

timingDate

There are no (further) constraints on this element

Data Type

timingPeriod

There are no (further) constraints on this element

Data Type

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())

Mappings

rim:n/a

valueBoolean

There are no (further) constraints on this element

Data Type

valueString

There are no (further) constraints on this element

Data Type

valueQuantity

There are no (further) constraints on this element

Data Type

valueAttachment

There are no (further) constraints on this element

Data Type

valueReference

There are no (further) constraints on this element

Data Type

reason

0..1

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

MissingToothReasonCodes (example)

Binding

Reason codes for the missing teeth.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

diagnosis

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
workflow:Request.reasonReference

sequence

1..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

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())

Mappings

rim:n/a

diagnosisCodeableConcept

There are no (further) constraints on this element

Data Type

diagnosisReference

There are no (further) constraints on this element

Data Type

type

0..*

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

ExampleDiagnosisTypeCodes (example)

Binding

The type of the diagnosis: admitting, principal, discharge.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

onAdmission

0..1

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.

Comments

Data Type

ExampleDiagnosisOnAdmissionCodes (example)

Binding

Present on admission.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

packageCode

0..1

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

ExampleDiagnosisRelatedGroupCodes (example)

Binding

The DRG codes associated with the diagnosis.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

procedure

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

sequence

1..1

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

type

0..*

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

ExampleProcedureTypeCodes (example)

Binding

Example procedure type codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

date

0..1

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

ICD-10ProcedureCodes (example)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

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.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

procedureCodeableConcept

There are no (further) constraints on this element

Data Type

procedureReference

There are no (further) constraints on this element

Data Type

udi

0..*

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

insurance

S Σ

1..1

Element Id

Claim.insurance

Short description

Patient insurance information

Definition

For EPS this is the NHS Business Services Authority. The sequence value must always be 1.


"insurance":  [
    {
        "sequence": 1,
        "focal": true,
        "coverage": {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "T1450"
            },
            "display": "NHS BUSINESS SERVICES AUTHORITY"
        }
    }
],

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:Coverage

sequence

1..1

There are no (further) constraints on this element

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

focal

1..1

There are no (further) constraints on this element

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

identifier

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
workflow:Request.identifier
w5:FiveWs.identifier

coverage

Σ I

1..1

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

reference

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

1..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

uriFixed Value

Element Id

Claim.insurance.coverage.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/Id/ods-organization-code

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

stringFixed Value

Element Id

Claim.insurance.coverage.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

T1450

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

businessArrangement

0..1

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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

preAuthRef

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

claimResponse

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

accident

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

date

1..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

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.

Comments

Data Type

v3.ActIncidentCode (extensible)

Binding

Type of accident: work place, auto, etc.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

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())

Mappings

rim:n/a

locationAddress

There are no (further) constraints on this element

Data Type

locationReference

There are no (further) constraints on this element

Data Type

item

1..1

Element Id

Claim.item

Short description

Product or service provided

Definition

	item (prescription)	detail (requested medication)	subDetail (dispensed medication)
productOrService	16076005 Prescription	dm+d code of requested medication	dm+d code of dispensed medication
programCode	exemptionEvidence prescriptionChargeExemption	prescriptionCharge dispensingEndorsement additionalInstructions
modifier		MedicationDispenseType
quantity		MedicationRequest.quantity	MedicationDispense.quantity

Requirements

The items to be processed for adjudication.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

extension

1..*

Element Id

Claim.item.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

prescriptionStatus

S I

1..1

Element Id

Claim.item.extension:prescriptionStatus

Short description

Dispensing Prescription Status

Alternate names

extensions, user content

Definition

This will generally match the value of the last dispense-notification message.

This should match the status of the associated NHSDigital-Task


"extension": [
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus",
        "valueCoding": {
            "system": "https://fhir.nhs.uk/CodeSystem/EPS-task-business-status",
            "code": "0006",
            "display": "Dispensed"
        }
    }
]

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus

Extension 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
rim:N/A

prescriptionStatusReason

S I

0..1

Element Id

Claim.item.extension:prescriptionStatusReason

Short description

Prescription Status Reason

Alternate names

extensions, user content

Definition

Mandatory if the medication was not dispensed. This should match the statusReason of the associated NHSDigital-Task


"extension": [
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason",
        "valueCoding": {
            "system": "https://fhir.nhs.uk/ValueSet/DM-medicationdispense-status-reason",
            "code": "0001",
            "display": "Not required as instructed by the patient"
        }
    }
],

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason

Extension 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
rim:N/A

sequence

1..1

positiveIntFixed Value

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

Mappings

rim:n/a

careTeamSequence

0..*

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

diagnosisSequence

0..*

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

procedureSequence

0..*

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

informationSequence

0..*

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

revenue

0..1

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.

Comments

Data Type

Binding

Codes for the revenue or cost centers supplying the service and/or products.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

category

0..1

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

Binding

Benefit categories such as: oral-basic, major, glasses.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

productOrService

1..1

Element Id

Claim.item.productOrService

Short description

Billing, service, product, or drug code

Alternate names

Drug Code, Bill Code, Service Code

Definition

Mandatory fixed value.


"productOrService": {
    "coding":  [
        {
            "system": "http://snomed.info/sct",
            "code": "16076005",
            "display": "Prescription"
        }
    ]
},

Requirements

Necessary to state what was provided or done.

Comments

To be expanded. At present a fixed SNOMED CT value

Data Type

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())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

1..1

There are no (further) constraints on this element

Element Id

Claim.item.productOrService.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.item.productOrService.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

http://snomed.info/sct

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.productOrService.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

codeFixed Value

Element Id

Claim.item.productOrService.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

16076005

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

1..1

stringFixed Value

Element Id

Claim.item.productOrService.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

Prescription

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.productOrService.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.productOrService.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

modifier

0..*

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

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.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

programCode

0..*

Element Id

Claim.item.programCode

Short description

PrescriptionChargeExemption

Definition

Exemption evidence - code to denote which evidence for exemption has been seen.

Prescription Charge Exemption - code to denote the exemption reason


"programCode": [
    {
        "coding": [
              {
                "code": "0001",
                "system": "https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption",
                "display": "Patient has paid appropriate charges"
              }
            ]
          },
          {
            "coding": [
              {
                "system": "https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence",
                "code": "no-evidence-seen",
                "display": "No Evidence Seen"
              }
            ]
          }
        ]

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

Sliced:

Unordered, Open, by coding.system(Value)

Binding

Prescription Charge Exemption

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

(All Slices)

There are no (further) constraints on this element

coding

1..*

There are no (further) constraints on this element

Element Id

Claim.item.programCode.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

exemptionEvidence

0..1

CodeableConceptBinding

Element Id

Claim.item.programCode:exemptionEvidence

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

NHSBSAPrescriptionExemptionEvidence (extensible)

Binding

Program specific reason codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

0..*

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.item.programCode:exemptionEvidence.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

prescriptionChargeExemption

1..1

CodeableConceptBinding

Element Id

Claim.item.programCode:prescriptionChargeExemption

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

DM-prescription-charge-exemption (required)

Binding

Prescription Charge Exemption

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

0..*

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.item.programCode:prescriptionChargeExemption.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

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

rim:n/a
w5:FiveWs.done[x]

servicedDate

There are no (further) constraints on this element

Data Type

servicedPeriod

There are no (further) constraints on this element

Data Type

ExampleServicePlaceCodes (example)

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.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
w5:FiveWs.where[x]

locationCodeableConcept

There are no (further) constraints on this element

Data Type

locationAddress

There are no (further) constraints on this element

Data Type

locationReference

There are no (further) constraints on this element

Data Type

quantity

0..1

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.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3:If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1:The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim:n/a
v2:SN (see also Range) or CQ
rim:PQ, IVL<PQ>, MO, CO, depending on the values

unitPrice

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

factor

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

net

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

udi

0..*

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

bodySite

0..1

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

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())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

subSite

0..*

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.

Comments

Data Type

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())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

encounter

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.context

detail

1..*

Element Id

Claim.item.detail

Short description

Product or service provided

Definition

A claim detail line. Relates to MedicationRequest

Requirements

The items to be processed for adjudication.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

extension

2..*

Element Id

Claim.item.detail.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

medicationRequest

S I

1..1

Element Id

Claim.item.detail.extension:medicationRequest

Short description

MedicationRequest reference

Alternate names

extensions, user content

Definition

This should match the identifier of the associated NHSDigital-MedicationRequest


"extension":  [
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference",
        "valueReference": {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/prescription-order-item-number",
                "value": "33560bee-bc0c-4e3b-a155-71591eee9ca5"
            }
        }
    }
],

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference

Extension 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
rim:N/A

sequenceIdentifier

S I

1..1

Element Id

Claim.item.detail.extension:sequenceIdentifier

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-ClaimSequenceIdentifier

Extension 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
rim:N/A

repeatInformation

0..1

Extension(Complex)

Element Id

Claim.item.detail.extension:repeatInformation

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation

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
rim:N/A

taskBusinessStatusReason

0..1

Element Id

Claim.item.detail.extension:taskBusinessStatusReason

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

To capture non-dispensing reason within a Claim at the line-item level

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason

Extension 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
rim:N/A

sequence

1..1

Element Id

Claim.item.detail.sequence

Short description

Item instance identifier

Definition

An integer to identify the item within the resource. Fixed value.


"sequence": 1,

Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

revenue

0..1

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.

Comments

Data Type

Binding

Codes for the revenue or cost centers supplying the service and/or products.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

category

0..1

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

Binding

Benefit categories such as: oral-basic, major, glasses.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

productOrService

1..1

CodeableConceptBinding

Element Id

Claim.item.detail.productOrService

Short description

Billing, service, product, or drug code

Alternate names

Drug Code, Bill Code, Service Code

Definition

This should match the medicationCodeableConcept of the associated NHSDigital-MedicationRequest


"productOrService": {
    "coding":  [
        {
            "system": "http://snomed.info/sct",
            "code": "322237000",
            "display": "Paracetamol 500mg soluble tablets"
        }
    ]
},

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

Digital Medicine MedicationRequest Code (required)

Binding

DMD Medication Code

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

modifier

1..*

CodeableConceptBinding

Element Id

Claim.item.detail.modifier

Short description

Service/Product billing modifiers

Definition

If the code is 0002 - Item not dispensed then the extension prescriptionStatusReason is required.

This should match the type of the last associated NHSDigital-MedicationDispense


"modifier":  [
    {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-type",
                "code": "0001",
                "display": "Item fully dispensed"
            }
        ]
    }
],

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

MedicationDispenseType (required)

Binding

MedicationDispense Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

programCode

0..*

Element Id

Claim.item.detail.programCode

Short description

Dispensing Endorsement and Charge Payment

Definition

Dispensing Endorsement - Details of the endorsement(s) to support the claim for this medication item.

Charge Payment - Details on whether a prescription charge was paid for the medication treatment.


"programCode":  [
    {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/DM-prescription-charge",
                "code": "paid-once",
                "display": "Paid Once"
            }
        ]
    },
    {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement",
                "code": "IP",
                "display": "Invoice Price"
            }
        ]
    }
],

If an endorsement code of PD is used, the number of packaged doses dispensed minus the number of dispenses must be entered in the programCode.text field e.g. PD4 for five doses packaged separately and dispensed on one occasion

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

Sliced:

Unordered, Open, by coding.system(Value)

Binding

Program specific reason codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

(All Slices)

There are no (further) constraints on this element

coding

S Σ

1..*

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

prescriptionCharge

1..1

CodeableConceptBinding

Element Id

Claim.item.detail.programCode:prescriptionCharge

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

NHSBSAPrescriptionCharge (required)

Binding

Program specific reason codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

0..*

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

0..1

uriFixed Value

Element Id

Claim.item.detail.programCode:prescriptionCharge.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/CodeSystem/DM-prescription-charge

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

dispensingEndorsement

0..*

CodeableConceptBinding

Element Id

Claim.item.detail.programCode:dispensingEndorsement

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

NHSBSADispensingEndorsement (required)

Binding

Program specific reason codes

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

0..*

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

0..1

uriFixed Value

Element Id

Claim.item.detail.programCode:dispensingEndorsement.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

Element Id

Claim.item.detail.programCode:dispensingEndorsement.text

Short description

Additional Information for Dispensing Endorsements

Definition

Additional Information for Dispensing Endorsements should be entered in this field. Details on the format of this text field can be found in Requirements and Electronic Prescription Service Guidance for Endorsement (EPS)

       {
                "coding": [
                    {
                       "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement",
                       "code": "IP",
                       "display": "Invoice Price for less common products or special items"
                      }
                   ],
                  "text" : "15gram,£12.34,EFGH Ltd"
          },
          {
                "coding": [
                    {
                       "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement",
                       "code": "PD",
                       "display": "Packaged Doses"
                      }
                   ],
                  "text" : "PD4"
          }

Requirements

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

quantity

S I

0..1

Element Id

Claim.item.detail.quantity

Short description

Count of products or services

Definition

This should match the quantity of the associated NHSDigital-MedicationRequest


"quantity": {
    "value": 200,
    "unit": "unit dose",
    "system": "http://snomed.info/sct",
    "code": "408102007"
},

Requirements

Required when the product or service code does not convey the quantity provided.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3:If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1:The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim:n/a
v2:SN (see also Range) or CQ
rim:PQ, IVL<PQ>, MO, CO, depending on the values

unitPrice

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

factor

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.factor

Short description

Price scaling factor

Definition

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

net

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

udi

0..*

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

subDetail

0..*

Element Id

Claim.item.detail.subDetail

Short description

Product or service provided

Definition

subDetail is only present if the medication has been dispensed.

Requirements

The items to be processed for adjudication.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

extension

0..*

Element Id

Claim.item.detail.subDetail.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

medicationDispense

0..1

Element Id

Claim.item.detail.subDetail.extension:medicationDispense

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationDispenseReference

Extension 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
rim:N/A

repeatInformation

0..1

Extension(Complex)

Element Id

Claim.item.detail.subDetail.extension:repeatInformation

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation

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
rim:N/A

sequence

1..1

Element Id

Claim.item.detail.subDetail.sequence

Short description

Item instance identifier

Definition

An integer id for each medication dispense.


"sequence": 1,

Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

revenue

0..1

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.

Comments

Data Type

Binding

Codes for the revenue or cost centers supplying the service and/or products.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

category

0..1

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

Binding

Benefit categories such as: oral-basic, major, glasses.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

productOrService

1..1

CodeableConceptBinding

Element Id

Claim.item.detail.subDetail.productOrService

Short description

Billing, service, product, or drug code

Definition

This should match the medicationCodeableConcept of the associated NHSDigital-MedicationDispense


"productOrService": {
    "coding":  [
        {
            "system": "http://snomed.info/sct",
            "code": "3416211000001106",
            "display": "Salbutamol 100micrograms/dose inhaler (Sandoz Ltd) 200 dose"
        }
    ]
},

Requirements

Necessary to state what was provided or done.

Comments

Data Type

Digital Medicine MedicationDispense Code (extensible)

Binding

DMD Medication Code

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

modifier

0..*

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

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.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

programCode

0..*

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

Binding

Program specific reason codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

quantity

S I

1..1

Element Id

Claim.item.detail.subDetail.quantity

Short description

Count of products or services

Definition

This should match the quantity of the associated NHSDigital-MedicationDispense


"quantity": {
    "value": 200,
    "unit": "unit dose",
    "system": "http://snomed.info/sct",
    "code": "408102007"
}

Requirements

Required when the product or service code does not convey the quantity provided.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3:If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1:The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim:n/a
v2:SN (see also Range) or CQ
rim:PQ, IVL<PQ>, MO, CO, depending on the values

extension

0..*

Element Id

Claim.item.detail.subDetail.quantity.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

runningTotal

0..1

Element Id

Claim.item.detail.subDetail.quantity.extension:runningTotal

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-RunningTotal

Extension 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
rim:N/A

value

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.value

Short description

Numerical value (with implicit precision)

Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:SN.2 / CQ - N/A
rim:PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value

comparator

Σ ?!

0..0

codeBinding

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.comparator

Short description

< | <= | >= | > - how to understand the value

Definition

Not allowed to be used in this context

Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Meaning When Missing

If there is no comparator, then there is no modification of the value

Data Type

Binding

How the Quantity should be understood and represented.

QuantityComparator (required)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:SN.1 / CQ.1
rim:IVL properties

unit

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.unit

Short description

Unit representation

Definition

A human-readable form of the unit.

Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:(see OBX.6 etc.) / CQ.2
rim:PQ.unit

system

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.system

Short description

System that defines coded unit form

Definition

The identification of the system that provides the coded form of the unit.

Requirements

Need to know the system that defines the coded form of the unit.

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:(see OBX.6 etc.) / CQ.2
rim:CO.codeSystem, PQ.translation.codeSystem

code

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.code

Short description

Coded form of the unit

Definition

A computer processable form of the unit in some unit representation system.

Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:(see OBX.6 etc.) / CQ.2
rim:PQ.code, MO.currency, PQ.translation.code

unitPrice

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

factor

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.factor

Short description

Price scaling factor

Definition

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

net

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

udi

0..*

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

total

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

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

Data Type

Claim

Constraints

dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.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-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-6:A resource should have narrative for robust management
text.`div`.exists()
dom-5:If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty()

Mappings

rim:Entity. Role, or Act
workflow:Request

extension

0..*

Element Id

Claim.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

replacementOf

S I

0..1

Element Id

Claim.extension:replacementOf

Short description

Used to reference a previous Claim

Alternate names

extensions, user content

Definition

Used for replacement Claims, this should reference the Claim.identifier of the Claim being replaced.


  "extension":  [
        {
            "url": "https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf",
            "valueIdentifier": {
                "value": "46055273-3001-41bd-86a0-f8dba7f2161a"
            }
        }
    ],

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-replacementOf

Extension 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
rim:N/A

agent

S I

0..1

Extension(Reference(NHSDigitalPractitionerRole | NHSDigitalPractitioner | NHSDigitalHealthcareService))

Element Id

Claim.extension:agent

Short description

Provenance of the resource

Alternate names

extensions, user content

Definition

The person submitting/authoring the Claim


   "extension":  [
        {
            "url": "https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent",
            "valueReference": {
                "identifier": {
                    "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
                    "value": "884562163557"
                },
                "display": "dummy full name"
            }
        }
    ],

Comments

Data Type

Extension(Reference(NHSDigitalPractitionerRole | NHSDigitalPractitioner | NHSDigitalHealthcareService))

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-Provenance-agent

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
rim:N/A

supplyHeaderIdentifier

S I

0..1

Element Id

Claim.extension:supplyHeaderIdentifier

Short description

Identifier for the SupplyHeader

Alternate names

extensions, user content

Definition

Identifier of the SupplyHeader (v3) object. The prescription in the context of a Dispense Notification or Claim. Mandatory for EPS interactions.

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-SupplyHeaderIdentifier

Extension 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
rim:N/A

identifier

1..*

Element Id

Claim.identifier

Short description

Business Identifier for claim

Alternate names

Claim Number

Definition

MUST be unique for each Claim. In EPS this must be a UUID with a system of https://fhir.nhs.uk/Id/prescription-dispense-item-number


      "identifier":  [
          {
              "system": "https://fhir.nhs.uk/Id/prescription-dispense-item-number",
              "value": "4509B70D-D8B8-EA03-1105-64557CB54A29"
          }
      ],

Requirements

Allows claims to be distinguished and referenced.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
workflow:Request.identifier
w5:FiveWs.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

There are no (further) constraints on this element

Element Id

Claim.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

status

S Σ ?!

1..1

codeBinding

Element Id

Claim.status

Short description

active | cancelled | draft | entered-in-error

Definition

For EPS the following MUST be used.


      "status": "active",
      "type": {
          "coding":  [
              {
                   "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy",
                    "display": "Pharmacy"
             }             
          ]
      },
      "use": "claim",

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

FinancialResourceStatusCodes (required)

Binding

A code specifying the state of the resource instance.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
workflow:Request.status
w5:FiveWs.status

type

S Σ

1..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.type

Short description

Category or discipline

Definition

The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

Requirements

Claim type determine the general sets of business rules applied for information requirements and adjudication.

Comments

Data Type

Binding

The type or discipline-style of the claim.

ClaimTypeCodes (extensible)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
w5:FiveWs.class

coding

1..*

There are no (further) constraints on this element

Element Id

Claim.type.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.type.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

http://terminology.hl7.org/CodeSystem/claim-type

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.type.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

codeFixed Value

Element Id

Claim.type.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

pharmacy

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.type.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.type.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.type.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

subType

0..1

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

ExampleClaimSubTypeCodes (example)

Binding

A more granular claim typecode.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
w5:FiveWs.class

use

1..1

codeBindingFixed Value

Element Id

Claim.use

Short description

claim | preauthorization | predetermination

Definition

Requirements

This element is required to understand the nature of the request for adjudication.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

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())

Fixed Value

claim

Mappings

rim:n/a
w5:FiveWs.class

patient

S Σ I

1..1

Element Id

Claim.patient

Short description

The recipient of the products and services

Definition

MUST be an identifier reference using the Patients NHS Number.


      "patient": {
          "identifier": {
              "system": "https://fhir.nhs.uk/Id/nhs-number",
              "value": "2300992742"
          }
      },

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
patient-reference:An identifier reference or resource reference must be provided
(reference.exists() or identifier.exists())
patient-nhs:Length of the supplied NHS Number is wrong.
identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists().not() or (identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists() and identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').value.matches('^([0-9]{10})$'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.subject
w5:FiveWs.subject[x]
w5:FiveWs.subject

reference

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.patient.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.patient.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

1..1

There are no (further) constraints on this element

Element Id

Claim.patient.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

uriFixed Value

Element Id

Claim.patient.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/Id/nhs-number

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.patient.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.patient.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

billablePeriod

Σ I

0..1

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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
w5:FiveWs.done[x]

created

S Σ

1..1

Element Id

Claim.created

Short description

Resource creation date

Definition

The date of the Claim


  "created": "2004-09-16T16:30:00+00:00",

Requirements

Need to record a timestamp for use by both the recipient and the issuer.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
workflow:Request.authoredOn
w5:FiveWs.recorded

enterer

0..1

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5:FiveWs.author

insurer

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.insurer

Short description

Target

Definition

The Insurer who is target of the request.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.performer

provider

S Σ I

1..1

Element Id

Claim.provider

Short description

Party responsible for the claim

Definition

The organisation responsible for the claim, this must be a reference to a contained PractitoinerRole

 "provider": {
        "reference" : "#provider"
    },

The contained PractitionerRole

{
    "resourceType": "Claim",
    "id": "258E153F-567B-4D60-B045-BA315A6B8DB0",
    "contained": [
  {
      "resourceType": "PractitionerRole",
      "id": "provider",
      "identifier": [
        {
          "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
          "value": "454567759542"
        }
      ],
      "code": [
        {
          "coding": [
            {
              "system": "https://fhir.nhs.uk/CodeSystem/NHSDigital-SDS-JobRoleCode",
              "code": "S0030:G0100:R0620"
            }
          ]
        }
      ],
      "practitioner": {
        "identifier": {
          "system": "https://fhir.nhs.uk/Id/sds-user-id",
          "value": "7654321"
        },
        "display": "Mr Peter Potion"
      },
      "organization": {
        "reference": "#organisation"
      },
      "telecom": [
        {
          "system": "phone",
          "use": "work",
          "value": "01234567890"
        }
      ]
    },
    {
      "resourceType": "Organization",
      "id": "organisation",
      "identifier": [
        {
          "system": "https://fhir.nhs.uk/Id/ods-organization-code",
          "value": "VNE51"
        }
      ],
      "address": [
        {
          "city": "West Yorkshire",
          "use": "work",
          "line": [
            "17 Austhorpe Road",
            "Crossgates",
            "Leeds"
          ],
          "postalCode": "LS15 8BA"
        }
      ],
      "active": true,
      "type": [
        {
          "coding": [
            {
              "system": "https://fhir.nhs.uk/CodeSystem/organisation-role",
              "code": "182",
              "display": "PHARMACY"
            }
          ]
        }
      ],
      "name": "The Simple Pharmacy",
      "telecom": [
        {
          "system": "phone",
          "use": "work",
          "value": "0113 3180277"
        }
      ]
    }        
    ],

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

Allowed aggregation: contained

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.requester
w5:FiveWs.source

reference

Σ I

1..1

There are no (further) constraints on this element

Element Id

Claim.provider.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.provider.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

0..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.provider.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.provider.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

priority

S Σ

1..1

Element Id

Claim.priority

Short description

Desired processing ugency

Definition

Desired processing ugency. Fixed value.

"priority": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/processpriority",
                "code": "normal"
            }
        ]
    }

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

ProcessPriorityCodes (example)

Binding

The timeliness with which processing is required: stat, normal, deferred.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow:Request.priority

coding

1..1

There are no (further) constraints on this element

Element Id

Claim.priority.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.priority.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

http://terminology.hl7.org/CodeSystem/processpriority

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.priority.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

codeFixed Value

Element Id

Claim.priority.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

normal

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.priority.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.priority.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.priority.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

fundsReserve

0..1

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

Comments

This field is only used for preauthorizations.

Data Type

Funds Reservation Codes (example)

Binding

For whom funds are to be reserved: (Patient, Provider, None).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

claim

0..1

There are no (further) constraints on this element

Element Id

Claim.related.claim

Short description

Reference to the related claim

Definition

Reference to a related claim.

Requirements

For workplace or other accidents it is common to relate separate claims arising from the same event.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.replaces

relationship

0..1

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

Binding

Relationship of this claim to a related Claim.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

reference

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier

prescription

S I

1..1

Reference(DeviceRequest | MedicationRequest | VisionPrescription)

Element Id

Claim.prescription

Short description

Prescription authorizing services and products

Definition

References to the original prescription, the groupIdentifier contains both the ShortForm prescription id and long form UUID variant. See NHSDigital-MedicationRequest for more details.

This MUST not be used to reference the MedicationRequest.


"prescription": {
    "extension": [
        {
            "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier",
            "extension": [
                {
                    "url": "shortForm",
                    "valueIdentifier": {
                        "system": "https://fhir.nhs.uk/Id/prescription-order-number",
                        "value": "82D996-C81010-11DB12"
                    }
                },
                {
                    "url": "UUID",
                    "valueIdentifier": {
                        "system": "https://fhir.nhs.uk/Id/prescription",
                        "value": "b2fc79f0-2793-4736-9b2d-0976c21e73a5"
                    }
                }
            ]
        }
    ]
},

Requirements

Required to authorize the dispensing of controlled substances and devices.

Comments

Data Type

Reference(DeviceRequest | MedicationRequest | VisionPrescription)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

extension

1..*

Element Id

Claim.prescription.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

groupIdentifier

1..1

Extension(Complex)

Element Id

Claim.prescription.extension:groupIdentifier

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

Extension(Complex)

Extension 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
rim:N/A

reference

Σ I

0..0

There are no (further) constraints on this element

Element Id

Claim.prescription.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.prescription.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

0..0

There are no (further) constraints on this element

Element Id

Claim.prescription.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

display

0..1

There are no (further) constraints on this element

Element Id

Claim.prescription.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

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

Data Type

Reference(DeviceRequest | MedicationRequest | VisionPrescription)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

extension

1..*

Element Id

Claim.originalPrescription.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-GroupIdentifier

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

groupIdentifier

1..1

Extension(Complex)

Element Id

Claim.originalPrescription.extension:groupIdentifier

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

Extension(Complex)

Extension 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
rim:N/A

reference

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.originalPrescription.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

payee

1..1

Element Id

Claim.payee

Short description

Recipient of benefits payable

Definition

The recipient of benefits payable. This is the ODS Code of the Pharmacy (provider) making the Claim.

See provider for example of a contained Organization.


"payee": {
    "type": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                "value": "provider",
                "display": "Provider"
            }
        ]
    },
    "party": {
        "reference": "#organisation",
        "display": "The Simple Pharmacy"
    }
}

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

type

1..1

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.

Comments

Data Type

Claim Payee Type Codes (example)

Binding

A code for the party to be reimbursed.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

1..*

There are no (further) constraints on this element

Element Id

Claim.payee.type.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.payee.type.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

http://terminology.hl7.org/CodeSystem/payeetype

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.type.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

codeFixed Value

Element Id

Claim.payee.type.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

provider

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

1..1

stringFixed Value

Element Id

Claim.payee.type.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

Provider

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.type.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.type.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

party

1..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
nhsd-claim-party:party - An identifier reference or resource reference must be provided
(reference.exists() or (identifier.exists()))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

reference

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.payee.party.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

uriFixed Value

Element Id

Claim.payee.party.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/Id/ods-organization-code

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.payee.party.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

referral

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5:FiveWs.cause

facility

0..1

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5:FiveWs.where[x]

careTeam

0..*

There are no (further) constraints on this element

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

sequence

1..1

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

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.

Comments

Data Type

Reference(Practitioner | PractitionerRole | Organization)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5:FiveWs.actor

responsible

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

role

0..1

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

ClaimCareTeamRoleCodes (example)

Binding

The role codes for the care team members.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

qualification

0..1

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.

Comments

Data Type

ExampleProviderQualificationCodes (example)

Binding

Provider professional qualifications.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

supportingInfo

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
workflow:Request.supportingInfo

sequence

1..1

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

category

1..1

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

ClaimInformationCategoryCodes (example)

Binding

The valuset used for additional information category codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

code

0..1

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.

Comments

Data Type

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())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

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())

Mappings

rim:n/a

timingDate

There are no (further) constraints on this element

Data Type

timingPeriod

There are no (further) constraints on this element

Data Type

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())

Mappings

rim:n/a

valueBoolean

There are no (further) constraints on this element

Data Type

valueString

There are no (further) constraints on this element

Data Type

valueQuantity

There are no (further) constraints on this element

Data Type

valueAttachment

There are no (further) constraints on this element

Data Type

valueReference

There are no (further) constraints on this element

Data Type

reason

0..1

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

MissingToothReasonCodes (example)

Binding

Reason codes for the missing teeth.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

diagnosis

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
workflow:Request.reasonReference

sequence

1..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

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())

Mappings

rim:n/a

diagnosisCodeableConcept

There are no (further) constraints on this element

Data Type

diagnosisReference

There are no (further) constraints on this element

Data Type

type

0..*

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

ExampleDiagnosisTypeCodes (example)

Binding

The type of the diagnosis: admitting, principal, discharge.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

onAdmission

0..1

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.

Comments

Data Type

ExampleDiagnosisOnAdmissionCodes (example)

Binding

Present on admission.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

packageCode

0..1

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

Data Type

ExampleDiagnosisRelatedGroupCodes (example)

Binding

The DRG codes associated with the diagnosis.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

procedure

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

sequence

1..1

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

type

0..*

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

ExampleProcedureTypeCodes (example)

Binding

Example procedure type codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

date

0..1

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

ICD-10ProcedureCodes (example)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

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.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

procedureCodeableConcept

There are no (further) constraints on this element

Data Type

procedureReference

There are no (further) constraints on this element

Data Type

udi

0..*

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

insurance

S Σ

1..1

Element Id

Claim.insurance

Short description

Patient insurance information

Definition

For EPS this is the NHS Business Services Authority. The sequence value must always be 1.


"insurance":  [
    {
        "sequence": 1,
        "focal": true,
        "coverage": {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "T1450"
            },
            "display": "NHS BUSINESS SERVICES AUTHORITY"
        }
    }
],

Requirements

At least one insurer is required for a claim to be a claim.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:Coverage

sequence

1..1

There are no (further) constraints on this element

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

focal

1..1

There are no (further) constraints on this element

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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

identifier

0..1

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

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
workflow:Request.identifier
w5:FiveWs.identifier

coverage

Σ I

1..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage

Short description

Insurance information

Definition

Requirements

Required to allow the adjudicator to locate the correct policy and history within their information system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

reference

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data Type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

identifier

1..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd:Identifier
rim:.identifier

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data Type

Binding

Identifies the purpose for this identifier, if known .

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:N/A
rim:Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Data Type

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
v2:CX.5
rim:Role.code or implied by context

system

1..1

uriFixed Value

Element Id

Claim.insurance.coverage.identifier.system

Short description

The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/Id/ods-organization-code

Mappings

rim:n/a
v2:CX.4 / EI-2-4
rim:II.root or Role.id.root
servd:./IdentifierType

value

1..1

stringFixed Value

Element Id

Claim.insurance.coverage.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

T1450

Mappings

rim:n/a
v2:CX.1 / EI.1
rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd:./Value

period

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
per-1:If present, start SHALL have a lower value than end
start.hasValue().not() or end.hasValue().not() or (start <= end)

Mappings

rim:n/a
v2:DR
rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2:CX.7 + CX.8
rim:Role.effectiveTime or implied by context
servd:./StartDate and ./EndDate

assigner

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2:CX.4 / (CX.4,CX.9,CX.10)
rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd:./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element Id

Claim.insurance.coverage.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:N/A

businessArrangement

0..1

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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

preAuthRef

0..*

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

claimResponse

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

accident

0..1

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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

date

1..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

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.

Comments

Data Type

v3.ActIncidentCode (extensible)

Binding

Type of accident: work place, auto, etc.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

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())

Mappings

rim:n/a

locationAddress

There are no (further) constraints on this element

Data Type

locationReference

There are no (further) constraints on this element

Data Type

item

1..1

Element Id

Claim.item

Short description

Product or service provided

Definition

	item (prescription)	detail (requested medication)	subDetail (dispensed medication)
productOrService	16076005 Prescription	dm+d code of requested medication	dm+d code of dispensed medication
programCode	exemptionEvidence prescriptionChargeExemption	prescriptionCharge dispensingEndorsement additionalInstructions
modifier		MedicationDispenseType
quantity		MedicationRequest.quantity	MedicationDispense.quantity

Requirements

The items to be processed for adjudication.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

extension

1..*

Element Id

Claim.item.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

prescriptionStatus

S I

1..1

Element Id

Claim.item.extension:prescriptionStatus

Short description

Dispensing Prescription Status

Alternate names

extensions, user content

Definition

This will generally match the value of the last dispense-notification message.

This should match the status of the associated NHSDigital-Task


"extension": [
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus",
        "valueCoding": {
            "system": "https://fhir.nhs.uk/CodeSystem/EPS-task-business-status",
            "code": "0006",
            "display": "Dispensed"
        }
    }
]

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus

Extension 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
rim:N/A

prescriptionStatusReason

S I

0..1

Element Id

Claim.item.extension:prescriptionStatusReason

Short description

Prescription Status Reason

Alternate names

extensions, user content

Definition

Mandatory if the medication was not dispensed. This should match the statusReason of the associated NHSDigital-Task


"extension": [
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason",
        "valueCoding": {
            "system": "https://fhir.nhs.uk/ValueSet/DM-medicationdispense-status-reason",
            "code": "0001",
            "display": "Not required as instructed by the patient"
        }
    }
],

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason

Extension 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
rim:N/A

sequence

1..1

positiveIntFixed Value

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

Mappings

rim:n/a

careTeamSequence

0..*

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

diagnosisSequence

0..*

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

procedureSequence

0..*

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

informationSequence

0..*

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.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

revenue

0..1

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.

Comments

Data Type

Binding

Codes for the revenue or cost centers supplying the service and/or products.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

category

0..1

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

Binding

Benefit categories such as: oral-basic, major, glasses.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

productOrService

1..1

Element Id

Claim.item.productOrService

Short description

Billing, service, product, or drug code

Alternate names

Drug Code, Bill Code, Service Code

Definition

Mandatory fixed value.


"productOrService": {
    "coding":  [
        {
            "system": "http://snomed.info/sct",
            "code": "16076005",
            "display": "Prescription"
        }
    ]
},

Requirements

Necessary to state what was provided or done.

Comments

To be expanded. At present a fixed SNOMED CT value

Data Type

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())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

1..1

There are no (further) constraints on this element

Element Id

Claim.item.productOrService.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.item.productOrService.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

http://snomed.info/sct

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.productOrService.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

codeFixed Value

Element Id

Claim.item.productOrService.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

16076005

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

1..1

stringFixed Value

Element Id

Claim.item.productOrService.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

Prescription

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.productOrService.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.productOrService.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

modifier

0..*

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

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.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

programCode

0..*

Element Id

Claim.item.programCode

Short description

PrescriptionChargeExemption

Definition

Exemption evidence - code to denote which evidence for exemption has been seen.

Prescription Charge Exemption - code to denote the exemption reason


"programCode": [
    {
        "coding": [
              {
                "code": "0001",
                "system": "https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption",
                "display": "Patient has paid appropriate charges"
              }
            ]
          },
          {
            "coding": [
              {
                "system": "https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence",
                "code": "no-evidence-seen",
                "display": "No Evidence Seen"
              }
            ]
          }
        ]

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

Sliced:

Unordered, Open, by coding.system(Value)

Binding

Prescription Charge Exemption

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

(All Slices)

There are no (further) constraints on this element

coding

1..*

There are no (further) constraints on this element

Element Id

Claim.item.programCode.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

exemptionEvidence

0..1

CodeableConceptBinding

Element Id

Claim.item.programCode:exemptionEvidence

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

NHSBSAPrescriptionExemptionEvidence (extensible)

Binding

Program specific reason codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

0..*

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.item.programCode:exemptionEvidence.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:exemptionEvidence.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

prescriptionChargeExemption

1..1

CodeableConceptBinding

Element Id

Claim.item.programCode:prescriptionChargeExemption

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

DM-prescription-charge-exemption (required)

Binding

Prescription Charge Exemption

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

0..*

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

uriFixed Value

Element Id

Claim.item.programCode:prescriptionChargeExemption.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.programCode:prescriptionChargeExemption.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

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

rim:n/a
w5:FiveWs.done[x]

servicedDate

There are no (further) constraints on this element

Data Type

servicedPeriod

There are no (further) constraints on this element

Data Type

ExampleServicePlaceCodes (example)

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.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
w5:FiveWs.where[x]

locationCodeableConcept

There are no (further) constraints on this element

Data Type

locationAddress

There are no (further) constraints on this element

Data Type

locationReference

There are no (further) constraints on this element

Data Type

quantity

0..1

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.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3:If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1:The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim:n/a
v2:SN (see also Range) or CQ
rim:PQ, IVL<PQ>, MO, CO, depending on the values

unitPrice

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

factor

0..1

There are no (further) constraints on this element

Element Id

Claim.item.factor

Short description

Price scaling factor

Definition

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

net

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

udi

0..*

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

bodySite

0..1

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

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())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

subSite

0..*

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.

Comments

Data Type

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())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

encounter

0..*

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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow:Request.context

detail

1..*

Element Id

Claim.item.detail

Short description

Product or service provided

Definition

A claim detail line. Relates to MedicationRequest

Requirements

The items to be processed for adjudication.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

extension

2..*

Element Id

Claim.item.detail.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

medicationRequest

S I

1..1

Element Id

Claim.item.detail.extension:medicationRequest

Short description

MedicationRequest reference

Alternate names

extensions, user content

Definition

This should match the identifier of the associated NHSDigital-MedicationRequest


"extension":  [
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference",
        "valueReference": {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/prescription-order-item-number",
                "value": "33560bee-bc0c-4e3b-a155-71591eee9ca5"
            }
        }
    }
],

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationRequestReference

Extension 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
rim:N/A

sequenceIdentifier

S I

1..1

Element Id

Claim.item.detail.extension:sequenceIdentifier

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-ClaimSequenceIdentifier

Extension 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
rim:N/A

repeatInformation

0..1

Extension(Complex)

Element Id

Claim.item.detail.extension:repeatInformation

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation

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
rim:N/A

taskBusinessStatusReason

0..1

Element Id

Claim.item.detail.extension:taskBusinessStatusReason

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

To capture non-dispensing reason within a Claim at the line-item level

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatusReason

Extension 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
rim:N/A

sequence

1..1

Element Id

Claim.item.detail.sequence

Short description

Item instance identifier

Definition

An integer to identify the item within the resource. Fixed value.


"sequence": 1,

Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

revenue

0..1

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.

Comments

Data Type

Binding

Codes for the revenue or cost centers supplying the service and/or products.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

category

0..1

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

Binding

Benefit categories such as: oral-basic, major, glasses.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

productOrService

1..1

CodeableConceptBinding

Element Id

Claim.item.detail.productOrService

Short description

Billing, service, product, or drug code

Alternate names

Drug Code, Bill Code, Service Code

Definition

This should match the medicationCodeableConcept of the associated NHSDigital-MedicationRequest


"productOrService": {
    "coding":  [
        {
            "system": "http://snomed.info/sct",
            "code": "322237000",
            "display": "Paracetamol 500mg soluble tablets"
        }
    ]
},

Requirements

Necessary to state what was provided or done.

Comments

Data Type

Digital Medicine MedicationRequest Code (required)

Binding

DMD Medication Code

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

modifier

1..*

CodeableConceptBinding

Element Id

Claim.item.detail.modifier

Short description

Service/Product billing modifiers

Definition

If the code is 0002 - Item not dispensed then the extension prescriptionStatusReason is required.

This should match the type of the last associated NHSDigital-MedicationDispense


"modifier":  [
    {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-type",
                "code": "0001",
                "display": "Item fully dispensed"
            }
        ]
    }
],

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

MedicationDispenseType (required)

Binding

MedicationDispense Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

programCode

0..*

Element Id

Claim.item.detail.programCode

Short description

Dispensing Endorsement and Charge Payment

Definition

Dispensing Endorsement - Details of the endorsement(s) to support the claim for this medication item.

Charge Payment - Details on whether a prescription charge was paid for the medication treatment.


"programCode":  [
    {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/DM-prescription-charge",
                "code": "paid-once",
                "display": "Paid Once"
            }
        ]
    },
    {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement",
                "code": "IP",
                "display": "Invoice Price"
            }
        ]
    }
],

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

Sliced:

Unordered, Open, by coding.system(Value)

Binding

Program specific reason codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

(All Slices)

There are no (further) constraints on this element

coding

S Σ

1..*

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

1..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

prescriptionCharge

1..1

CodeableConceptBinding

Element Id

Claim.item.detail.programCode:prescriptionCharge

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

NHSBSAPrescriptionCharge (required)

Binding

Program specific reason codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

0..*

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

0..1

uriFixed Value

Element Id

Claim.item.detail.programCode:prescriptionCharge.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/CodeSystem/DM-prescription-charge

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:prescriptionCharge.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

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

dispensingEndorsement

0..*

CodeableConceptBinding

Element Id

Claim.item.detail.programCode:dispensingEndorsement

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

NHSBSADispensingEndorsement (required)

Binding

Program specific reason codes

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

coding

0..*

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim:CV
orim:fhir:Coding rdfs:subClassOf dt:CDCoding
v2:C*E.1-8, C*E.10-22
rim:union(., ./translation)
orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

system

0..1

uriFixed Value

Element Id

Claim.item.detail.programCode:dispensingEndorsement.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Fixed Value

https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement

Mappings

rim:n/a
v2:C*E.3
rim:./codeSystem
orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.7
rim:./codeSystemVersion
orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.1
rim:./code
orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.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.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.2 - but note this is not well followed
rim:CV.displayName
orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.programCode:dispensingEndorsement.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

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
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

0..1

Element Id

Claim.item.detail.programCode:dispensingEndorsement.text

Short description

Additional Information for Dispensing Endorsements

Definition

       {
                "coding": [
                    {
                       "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement",
                       "code": "IP",
                       "display": "Invoice Price for less common products or special items"
                      }
                   ],
                  "text" : "15gram,£12.34,EFGH Ltd"
          },
          {
                "coding": [
                    {
                       "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement",
                       "code": "PD",
                       "display": "Packaged Doses"
                      }
                   ],
                  "text" : "PD4"
          }

Requirements

Comments

Very often the text is the same as a displayName of one of the codings.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:C*E.9. But note many systems use C*E.2 for this
rim:./originalText[mediaType/code="text/plain"]/data
orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

quantity

S I

0..1

Element Id

Claim.item.detail.quantity

Short description

Count of products or services

Definition

This should match the quantity of the associated NHSDigital-MedicationRequest


"quantity": {
    "value": 200,
    "unit": "unit dose",
    "system": "http://snomed.info/sct",
    "code": "408102007"
},

Requirements

Required when the product or service code does not convey the quantity provided.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3:If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1:The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim:n/a
v2:SN (see also Range) or CQ
rim:PQ, IVL<PQ>, MO, CO, depending on the values

unitPrice

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

factor

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.factor

Short description

Price scaling factor

Definition

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

net

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

udi

0..*

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

subDetail

0..*

Element Id

Claim.item.detail.subDetail

Short description

Product or service provided

Definition

subDetail is only present if the medication has been dispensed.

Requirements

The items to be processed for adjudication.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

extension

0..*

Element Id

Claim.item.detail.subDetail.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

medicationDispense

0..1

Element Id

Claim.item.detail.subDetail.extension:medicationDispense

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-ClaimMedicationDispenseReference

Extension 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
rim:N/A

repeatInformation

0..1

Extension(Complex)

Element Id

Claim.item.detail.subDetail.extension:repeatInformation

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation

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
rim:N/A

sequence

1..1

Element Id

Claim.item.detail.subDetail.sequence

Short description

Item instance identifier

Definition

An integer id for each medication dispense.


"sequence": 1,

Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Comments

32 bit number; for values larger than this, use decimal

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

revenue

0..1

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.

Comments

Data Type

Binding

Codes for the revenue or cost centers supplying the service and/or products.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

category

0..1

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

Binding

Benefit categories such as: oral-basic, major, glasses.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

productOrService

1..1

CodeableConceptBinding

Element Id

Claim.item.detail.subDetail.productOrService

Short description

Billing, service, product, or drug code

Definition

This should match the medicationCodeableConcept of the associated NHSDigital-MedicationDispense


"productOrService": {
    "coding":  [
        {
            "system": "http://snomed.info/sct",
            "code": "3416211000001106",
            "display": "Salbutamol 100micrograms/dose inhaler (Sandoz Ltd) 200 dose"
        }
    ]
},

Requirements

Necessary to state what was provided or done.

Comments

Data Type

Digital Medicine MedicationDispense Code (extensible)

Binding

DMD Medication Code

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

modifier

0..*

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

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.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

programCode

0..*

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

Binding

Program specific reason codes.

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:CE/CNE/CWE
rim:CD
orim:fhir:CodeableConcept rdfs:subClassOf dt:CD

quantity

S I

1..1

Element Id

Claim.item.detail.subDetail.quantity

Short description

Count of products or services

Definition

This should match the quantity of the associated NHSDigital-MedicationDispense


"quantity": {
    "value": 200,
    "unit": "unit dose",
    "system": "http://snomed.info/sct",
    "code": "408102007"
}

Requirements

Required when the product or service code does not convey the quantity provided.

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3:If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1:The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim:n/a
v2:SN (see also Range) or CQ
rim:PQ, IVL<PQ>, MO, CO, depending on the values

extension

0..*

Element Id

Claim.item.detail.subDetail.quantity.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data Type

Sliced:

Unordered, Open, by url(Value)

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
rim:N/A

runningTotal

0..1

Element Id

Claim.item.detail.subDetail.quantity.extension:runningTotal

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data Type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-RunningTotal

Extension 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
rim:N/A

value

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.value

Short description

Numerical value (with implicit precision)

Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:SN.2 / CQ - N/A
rim:PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value

comparator

Σ ?!

0..0

codeBinding

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.comparator

Short description

< | <= | >= | > - how to understand the value

Definition

Not allowed to be used in this context

Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Meaning When Missing

If there is no comparator, then there is no modification of the value

Data Type

Binding

How the Quantity should be understood and represented.

QuantityComparator (required)

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:SN.1 / CQ.1
rim:IVL properties

unit

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.unit

Short description

Unit representation

Definition

A human-readable form of the unit.

Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:(see OBX.6 etc.) / CQ.2
rim:PQ.unit

system

Σ I

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.system

Short description

System that defines coded unit form

Definition

The identification of the system that provides the coded form of the unit.

Requirements

Need to know the system that defines the coded form of the unit.

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:(see OBX.6 etc.) / CQ.2
rim:CO.codeSystem, PQ.translation.codeSystem

code

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.quantity.code

Short description

Coded form of the unit

Definition

A computer processable form of the unit in some unit representation system.

Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
v2:(see OBX.6 etc.) / CQ.2
rim:PQ.code, MO.currency, PQ.translation.code

unitPrice

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

factor

0..1

There are no (further) constraints on this element

Element Id

Claim.item.detail.subDetail.factor

Short description

Price scaling factor

Definition

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a

net

0..1

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

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim:n/a
rim:MO

udi

0..*

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.

Comments

Data Type

Constraints

ele-1:All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1:SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

Mappings

rim:n/a
rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

total

0..1

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