NHS Digital FHIR Medicines

NHSDigital-Claim

Profile url FHIR Module Normative Status
https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim trial-use




idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
replacementOfS I0..1Extension(Identifier)
agentS I0..1Extension(Reference(NHSDigitalPractitionerRole | NHSDigitalPractitioner | NHSDigitalHealthcareService))
supplyHeaderIdentifierS I0..1Extension(Identifier)
modifierExtension?! I0..*Extension
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uri
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
statusS Σ ?!1..1codeBinding
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
subType0..1CodeableConcept
useΣ1..1codeBindingFixed Value
id0..1string
extensionI0..*Extension
referenceΣ I0..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
billablePeriodΣ I0..1Period
createdS Σ1..1dateTime
entererI0..1Reference(Practitioner | PractitionerRole)
insurerΣ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
referenceΣ I1..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uri
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
fundsReserve0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
claimI0..1Reference(Claim)
relationship0..1CodeableConcept
reference0..1Identifier
id0..1string
groupIdentifierI1..1Extension(Complex)
referenceΣ I0..0string
typeΣ0..1uriBinding
displayΣ0..1string
id0..1string
groupIdentifierI1..1Extension(Complex)
referenceΣ I0..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uri
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ1..1stringFixed Value
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
referenceΣ I0..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
referralI0..1Reference(ServiceRequest)
facilityI0..1Reference(Location)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveInt
providerI1..1Reference(Practitioner | PractitionerRole | Organization)
responsible0..1boolean
role0..1CodeableConcept
qualification0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveInt
category1..1CodeableConcept
code0..1CodeableConcept
timingDatedate
timingPeriodPeriod
valueBooleanboolean
valueStringstring
valueQuantityQuantity
valueAttachmentAttachment
valueReferenceReference(Resource)
reason0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveInt
diagnosisCodeableConceptCodeableConcept
diagnosisReferenceReference(Condition)
type0..*CodeableConcept
onAdmission0..1CodeableConcept
packageCode0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveInt
type0..*CodeableConcept
date0..1dateTime
procedureCodeableConceptCodeableConcept
procedureReferenceReference(Procedure)
udiI0..*Reference(Device)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequenceΣ1..1positiveInt
focalΣ1..1boolean
identifier0..1Identifier
id0..1string
extensionI0..*Extension
referenceΣ I0..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1stringFixed Value
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
businessArrangement0..1string
preAuthRef0..*string
claimResponseI0..1Reference(ClaimResponse)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
date1..1date
type0..1CodeableConceptBinding
locationAddressAddress
locationReferenceReference(Location)
id0..1string
prescriptionStatusS I1..1Extension(Coding)
prescriptionStatusReasonS I0..1Extension(Coding)
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveIntFixed Value
careTeamSequence0..*positiveInt
diagnosisSequence0..*positiveInt
procedureSequence0..*positiveInt
informationSequence0..*positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ1..1stringFixed Value
userSelectedΣ0..1boolean
textΣ0..1string
modifier0..*CodeableConcept
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
servicedDatedate
servicedPeriodPeriod
locationCodeableConceptCodeableConcept
locationAddressAddress
locationReferenceReference(Location)
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
bodySite0..1CodeableConcept
subSite0..*CodeableConcept
encounterI0..*Reference(Encounter)
id0..1string
medicationRequestS I1..1Extension(Reference(NHSDigitalMedicationRequest))
sequenceIdentifierS I1..1Extension(Identifier)
repeatInformationI0..1Extension(Complex)
taskBusinessStatusReasonI0..1Extension(Coding)
modifierExtensionΣ ?! I0..*Extension
sequenceS1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrServiceS1..1CodeableConceptBinding
modifierS1..*CodeableConceptBinding
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ0..1uriFixed Value
versionΣ0..1string
codeΣ0..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ0..1uriFixed Value
versionΣ0..1string
codeΣ0..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
quantityS I0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
id0..1string
medicationDispenseI0..1Extension(Reference(NHSDigitalMedicationDispense))
repeatInformationI0..1Extension(Complex)
modifierExtensionΣ ?! I0..*Extension
sequenceS1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrServiceS1..1CodeableConceptBinding
modifier0..*CodeableConcept
programCode0..*CodeableConcept
id0..1string
runningTotalI0..1Extension(Quantity)
valueΣ0..1decimal
comparatorΣ ?!0..0codeBinding
unitΣ0..1string
systemΣ I0..1uri
codeΣ0..1code
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
total0..1Money

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
replacementOfS I0..1Extension(Identifier)
agentS I0..1Extension(Reference(NHSDigitalPractitionerRole | NHSDigitalPractitioner | NHSDigitalHealthcareService))
supplyHeaderIdentifierS I0..1Extension(Identifier)
modifierExtension?! I0..*Extension
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uri
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
statusS Σ ?!1..1codeBinding
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
subType0..1CodeableConcept
useΣ1..1codeBindingFixed Value
id0..1string
extensionI0..*Extension
referenceΣ I0..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
billablePeriodΣ I0..1Period
createdS Σ1..1dateTime
entererI0..1Reference(Practitioner | PractitionerRole)
insurerΣ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
referenceΣ I1..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uri
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
fundsReserve0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
claimI0..1Reference(Claim)
relationship0..1CodeableConcept
reference0..1Identifier
id0..1string
groupIdentifierI1..1Extension(Complex)
referenceΣ I0..0string
typeΣ0..1uriBinding
displayΣ0..1string
id0..1string
groupIdentifierI1..1Extension(Complex)
referenceΣ I0..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uri
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ1..1stringFixed Value
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
referenceΣ I0..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
referralI0..1Reference(ServiceRequest)
facilityI0..1Reference(Location)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveInt
providerI1..1Reference(Practitioner | PractitionerRole | Organization)
responsible0..1boolean
role0..1CodeableConcept
qualification0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveInt
category1..1CodeableConcept
code0..1CodeableConcept
timingDatedate
timingPeriodPeriod
valueBooleanboolean
valueStringstring
valueQuantityQuantity
valueAttachmentAttachment
valueReferenceReference(Resource)
reason0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveInt
diagnosisCodeableConceptCodeableConcept
diagnosisReferenceReference(Condition)
type0..*CodeableConcept
onAdmission0..1CodeableConcept
packageCode0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveInt
type0..*CodeableConcept
date0..1dateTime
procedureCodeableConceptCodeableConcept
procedureReferenceReference(Procedure)
udiI0..*Reference(Device)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
sequenceΣ1..1positiveInt
focalΣ1..1boolean
identifier0..1Identifier
id0..1string
extensionI0..*Extension
referenceΣ I0..1string
typeΣ0..1uriBinding
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1stringFixed Value
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
displayΣ0..1string
businessArrangement0..1string
preAuthRef0..*string
claimResponseI0..1Reference(ClaimResponse)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
date1..1date
type0..1CodeableConceptBinding
locationAddressAddress
locationReferenceReference(Location)
id0..1string
prescriptionStatusS I1..1Extension(Coding)
prescriptionStatusReasonS I0..1Extension(Coding)
modifierExtensionΣ ?! I0..*Extension
sequence1..1positiveIntFixed Value
careTeamSequence0..*positiveInt
diagnosisSequence0..*positiveInt
procedureSequence0..*positiveInt
informationSequence0..*positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ1..1stringFixed Value
userSelectedΣ0..1boolean
textΣ0..1string
modifier0..*CodeableConcept
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
servicedDatedate
servicedPeriodPeriod
locationCodeableConceptCodeableConcept
locationAddressAddress
locationReferenceReference(Location)
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
bodySite0..1CodeableConcept
subSite0..*CodeableConcept
encounterI0..*Reference(Encounter)
id0..1string
medicationRequestS I1..1Extension(Reference(NHSDigitalMedicationRequest))
sequenceIdentifierS I1..1Extension(Identifier)
repeatInformationI0..1Extension(Complex)
taskBusinessStatusReasonI0..1Extension(Coding)
modifierExtensionΣ ?! I0..*Extension
sequenceS1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrServiceS1..1CodeableConceptBinding
modifierS1..*CodeableConceptBinding
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ0..1uriFixed Value
versionΣ0..1string
codeΣ0..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ0..1uriFixed Value
versionΣ0..1string
codeΣ0..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
quantityS I0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
id0..1string
medicationDispenseI0..1Extension(Reference(NHSDigitalMedicationDispense))
repeatInformationI0..1Extension(Complex)
modifierExtensionΣ ?! I0..*Extension
sequenceS1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrServiceS1..1CodeableConceptBinding
modifier0..*CodeableConcept
programCode0..*CodeableConcept
id0..1string
runningTotalI0..1Extension(Quantity)
valueΣ0..1decimal
comparatorΣ ?!0..0codeBinding
unitΣ0..1string
systemΣ I0..1uri
codeΣ0..1code
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
total0..1Money



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.

Comment

The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.

extension:replacementOf

Element Id Claim.extension:replacementOf
Cardinality 0..1
Slice Name replacementOf
type Extension(ExtensionreplacementOf)

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"
            }
        }
    ],


extension:agent

Element Id Claim.extension:agent
Cardinality 0..1
Slice Name agent
type Extension(ExtensionProvenanceAgent)

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"
            }
        }
    ],

identifier

Element Id Claim.identifier
Cardinality 1..*
type Identifier

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.

status

Element Id Claim.status
Cardinality 1..1
Terminology Binding FinancialResourceStatusCodes (Required)
A code specifying the state of the resource instance.
type code

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'.

Comment

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

type

Element Id Claim.type
Cardinality 1..1
Terminology Binding ClaimTypeCodes (Extensible)
The type or discipline-style of the claim.
type CodeableConcept

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.

Comment

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.

type.coding.system

Element Id Claim.type.coding.system
Cardinality 1..1
Fixed Value http://terminology.hl7.org/CodeSystem/claim-type
type uri

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.

Comment

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.

type.coding.code

Element Id Claim.type.coding.code
Cardinality 1..1
Fixed Value pharmacy
type code

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.

use

Element Id Claim.use
Cardinality 1..1
Fixed Value claim
Terminology Binding Use (Required)
The purpose of the Claim: predetermination, preauthorization, claim.
type code

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.

patient

Element Id Claim.patient
Cardinality 1..1
type Reference(Patient)

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.

Constraints

  • patient-reference (ERROR) An identifier reference or resource reference must be provided
  • patient-nhs (ERROR) Supplied NHS Number is outside the English and Welsh NHS Number range or length of the number is wrong.

patient.identifier.system

Element Id Claim.patient.identifier.system
Cardinality 1..1
Fixed Value https://fhir.nhs.uk/Id/nhs-number
type uri

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.

Comment

Identifier.system is always case sensitive.

created

Element Id Claim.created
Cardinality 1..1
type dateTime

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.

Comment

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.

provider

Element Id Claim.provider
Cardinality 1..1
type Reference(NHSDigitalPractitionerRoleSDS)
Aggregation - contained

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"
        }
      ]
    }        
    ],

Comment

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.

GMC Reference Number MUST NOT be used as a Practitioner identifier

priority

Element Id Claim.priority
Cardinality 1..1
Terminology Binding ProcessPriorityCodes (Example)
The timeliness with which processing is required: stat, normal, deferred.
type CodeableConcept

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.

Comment

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.

priority.coding.system

Element Id Claim.priority.coding.system
Cardinality 1..1
Fixed Value http://terminology.hl7.org/CodeSystem/processpriority
type uri

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.

Comment

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.

priority.coding.code

Element Id Claim.priority.coding.code
Cardinality 1..1
Fixed Value normal
type code

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.

prescription

Element Id Claim.prescription
Cardinality 1..1
type Reference(DeviceRequest MedicationRequest VisionPrescription)

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.

prescription.identifier.system

Element Id Claim.prescription.identifier.system
Cardinality 1..1
Fixed Value https://fhir.nhs.uk/Id/prescription-order-item-number
type uri

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.

Comment

Identifier.system is always case sensitive.

payee

Element Id Claim.payee
Cardinality 1..1
type BackboneElement

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.

Comment

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.

payee.type.coding.system

Element Id Claim.payee.type.coding.system
Cardinality 1..1
Fixed Value http://terminology.hl7.org/CodeSystem/payeetype
type uri

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.

Comment

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.

payee.type.coding.code

Element Id Claim.payee.type.coding.code
Cardinality 1..1
Fixed Value provider
type code

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.

payee.type.coding.display

Element Id Claim.payee.type.coding.display
Cardinality 1..1
type string

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.

payee.party.identifier.system

Element Id Claim.payee.party.identifier.system
Cardinality 1..1
Fixed Value https://fhir.nhs.uk/Id/ods-organization-code
type uri

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.

Comment

Identifier.system is always case sensitive.

insurance

Element Id Claim.insurance
Cardinality 1..1
type BackboneElement

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.

Comment

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.

insurance.coverage.identifier.system

Element Id Claim.insurance.coverage.identifier.system
Cardinality 1..1
Fixed Value https://fhir.nhs.uk/Id/ods-organization-code
type uri

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.

Comment

Identifier.system is always case sensitive.

insurance.coverage.identifier.value

Element Id Claim.insurance.coverage.identifier.value
Cardinality 1..1
type string

Definition

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

Comment

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.

item

Element Id Claim.item
Cardinality 1..1
type BackboneElement

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.

item.extension:prescriptionStatus

Element Id Claim.item.extension:prescriptionStatus
Cardinality 1..1
Slice Name prescriptionStatus
type Extension(ExtensionEPSTaskBusinessStatus)

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"
        }
    }
] 

item.extension:prescriptionStatusReason

Element Id Claim.item.extension:prescriptionStatusReason
Cardinality 0..1
Slice Name prescriptionStatusReason
type Extension(ExtensionEPSTaskBusinessStatusReason)

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"
        }
    }
],


item.sequence

Element Id Claim.item.sequence
Cardinality 1..1
type positiveInt

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.

item.productOrService.coding.system

Element Id Claim.item.productOrService.coding.system
Cardinality 1..1
Fixed Value http://snomed.info/sct
type uri

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.

Comment

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.

item.productOrService.coding.code

Element Id Claim.item.productOrService.coding.code
Cardinality 1..1
Fixed Value 16076005
type code

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.

item.productOrService.coding.display

Element Id Claim.item.productOrService.coding.display
Cardinality 1..1
type string

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.

item.programCode

Element Id Claim.item.programCode
Cardinality 0..*
Terminology Binding ExampleProgramReasonCodes (Example)
Prescription Charge Exemption
Slicing OPEN discriminator - VALUE coding.system
type CodeableConcept

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.

Comment

For example: Neonatal program, child dental program or drug users recovery program.

item.programCode:exemptionEvidence

Element Id Claim.item.programCode:exemptionEvidence
Cardinality 0..1
Terminology Binding NHSBSAPrescriptionExemptionEvidence (Extensible)
Slice Name exemptionEvidence
type CodeableConcept

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.

Comment

For example: Neonatal program, child dental program or drug users recovery program.

item.programCode:exemptionEvidence.coding.system

Element Id Claim.item.programCode:exemptionEvidence.coding.system
Cardinality 1..1
Fixed Value https://fhir.nhs.uk/CodeSystem/DM-exemption-evidence
type uri

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.

Comment

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.

item.programCode:prescriptionChargeExemption

Element Id Claim.item.programCode:prescriptionChargeExemption
Cardinality 1..1
Terminology Binding DMprescriptionchargeexemption (Required)
Prescription Charge Exemption
Slice Name prescriptionChargeExemption
type CodeableConcept

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.

Comment

For example: Neonatal program, child dental program or drug users recovery program.

item.programCode:prescriptionChargeExemption.coding.system

Element Id Claim.item.programCode:prescriptionChargeExemption.coding.system
Cardinality 1..1
Fixed Value https://fhir.nhs.uk/CodeSystem/prescription-charge-exemption
type uri

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.

Comment

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.

item.detail

Element Id Claim.item.detail
Cardinality 1..*
type BackboneElement

Definition

A claim detail line. Relates to MedicationRequest

Requirements

The items to be processed for adjudication.

item.detail.extension:medicationRequest

Element Id Claim.item.detail.extension:medicationRequest
Cardinality 1..1
Slice Name medicationRequest
type Extension(ExtensionClaimMedicationRequestReference)

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"
            }
        }
    }
],


item.detail.extension:sequenceIdentifier

Element Id Claim.item.detail.extension:sequenceIdentifier
Cardinality 1..1
Slice Name sequenceIdentifier
type Extension(ExtensionClaimSequenceIdentifier)

Definition

Optional Extension Element - found in all resources.

item.detail.sequence

Element Id Claim.item.detail.sequence
Cardinality 1..1
type positiveInt

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.

item.detail.productOrService

Element Id Claim.item.detail.productOrService
Cardinality 1..1
Terminology Binding DMMedicationRequestCode (Required)
DMD Medication Code
type CodeableConcept

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.

Comment

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'.

item.detail.modifier

Element Id Claim.item.detail.modifier
Cardinality 1..*
Terminology Binding MedicationDispenseType (Required)
MedicationDispense Type
type CodeableConcept

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.

Comment

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.

item.detail.programCode

Element Id Claim.item.detail.programCode
Cardinality 0..*
Terminology Binding ExampleProgramReasonCodes (Example)
Program specific reason codes.
Slicing OPEN discriminator - VALUE coding.system
type CodeableConcept

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.

Comment

For example: Neonatal program, child dental program or drug users recovery program.

item.detail.programCode.coding

Element Id Claim.item.detail.programCode.coding
Cardinality 1..*
type Coding

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.

Comment

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.

item.detail.programCode:prescriptionCharge

Element Id Claim.item.detail.programCode:prescriptionCharge
Cardinality 1..1
Terminology Binding NHSBSAPrescriptionCharge (Required)
Slice Name prescriptionCharge
type CodeableConcept

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.

Comment

For example: Neonatal program, child dental program or drug users recovery program.

item.detail.programCode:prescriptionCharge.coding.system

Element Id Claim.item.detail.programCode:prescriptionCharge.coding.system
Cardinality 0..1
Fixed Value https://fhir.nhs.uk/CodeSystem/DM-prescription-charge
type uri

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.

Comment

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.

item.detail.programCode:dispensingEndorsement

Element Id Claim.item.detail.programCode:dispensingEndorsement
Cardinality 0..*
Terminology Binding NHSBSADispensingEndorsement (Required)
Program specific reason codes
Slice Name dispensingEndorsement
type CodeableConcept

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.

Comment

For example: Neonatal program, child dental program or drug users recovery program.

item.detail.programCode:dispensingEndorsement.coding.system

Element Id Claim.item.detail.programCode:dispensingEndorsement.coding.system
Cardinality 0..1
Fixed Value https://fhir.nhs.uk/CodeSystem/medicationdispense-endorsement
type uri

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.

Comment

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.

item.detail.quantity

Element Id Claim.item.detail.quantity
Cardinality 0..1
type Quantity(SimpleQuantity)

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.

item.detail.subDetail

Element Id Claim.item.detail.subDetail
Cardinality 0..*
type BackboneElement

Definition

subDetail is only present if the medication has been dispensed.

Requirements

The items to be processed for adjudication.

item.detail.subDetail.sequence

Element Id Claim.item.detail.subDetail.sequence
Cardinality 1..1
type positiveInt

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.

item.detail.subDetail.productOrService

Element Id Claim.item.detail.subDetail.productOrService
Cardinality 1..1
Terminology Binding DMMedicationDispenseCode (Extensible)
DMD Medication Code
type CodeableConcept

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.

Comment

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'.

item.detail.subDetail.quantity

Element Id Claim.item.detail.subDetail.quantity
Cardinality 1..1
type Quantity(SimpleQuantity)

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.

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