{ "resourceType": "StructureDefinition", "id": "srx-fhir-profile-claim-medical-hum", "meta": { "lastUpdated": "2018-07-08T18:08:17.962+00:00" }, "url": "http://fhir-es.transcendinsights.com/stu3/StructureDefinition/srx-fhir-profile-claim-medical-hum", "name": "srx-fhir-profile-claim-medical-hum", "status": "draft", "date": "2018-07-03T18:53:04.038Z", "description": "Profile to record Humana medical claims.", "fhirVersion": "3.0.1", "mapping": [ { "identity": "MEDICAL-CLAIMS", "name": "Medical Claim" }, { "identity": "PATIENT-MED-CLM-CLIN-CODES", "name": "Clinical Codes for Medical Claims" } ], "kind": "resource", "abstract": false, "type": "Claim", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Claim", "derivation": "constraint", "differential": { "element": [ { "id": "Claim", "path": "Claim", "definition": "Medical claim submitted for payment" }, { "id": "Claim.id", "path": "Claim.id", "max": "0", "mustSupport": true }, { "id": "Claim.meta", "path": "Claim.meta", "min": 1 }, { "id": "Claim.meta.id", "path": "Claim.meta.id", "max": "0" }, { "id": "Claim.meta.profile", "path": "Claim.meta.profile", "min": 1, "max": "1" }, { "id": "Claim.meta.security", "path": "Claim.meta.security", "max": "0" }, { "id": "Claim.meta.tag", "path": "Claim.meta.tag", "max": "0" }, { "id": "Claim.meta.extension", "path": "Claim.meta.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" } }, { "id": "Claim.meta.Extension:resource-date-created", "path": "Claim.meta.extension", "sliceName": "resource-date-created", "short": "Creation date", "definition": "The date this resource was created (not the latest update).", "min": 1, "type": [ { "code": "Extension", "profile": "http://fhir-es.transcendinsights.com/stu3/StructureDefinition/resource-date-created" } ] }, { "id": "Claim.meta.Extension:data-source-entity", "path": "Claim.meta.extension", "sliceName": "data-source-entity", "short": "Source of data", "definition": "The entity producing the data e.g. Humana, Argus, EDW etc.", "type": [ { "code": "Extension", "profile": "http://fhir-es.transcendinsights.com/stu3/StructureDefinition/data-source-entity" } ] }, { "id": "Claim.meta.Extension:source-filename", "path": "Claim.meta.extension", "sliceName": "source-filename", "short": "Source data file names", "definition": "The name of the files that contain the source data.", "type": [ { "code": "Extension", "profile": "http://fhir-es.transcendinsights.com/stu3/StructureDefinition/source-filename" } ] }, { "id": "Claim.implicitRules", "path": "Claim.implicitRules", "max": "0" }, { "id": "Claim.language", "path": "Claim.language", "max": "0" }, { "id": "Claim.text", "path": "Claim.text", "max": "0" }, { "id": "Claim.contained", "path": "Claim.contained", "max": "0" }, { "id": "Claim.identifier", "path": "Claim.identifier", "definition": "The business identifier for the instance: claim number", "min": 1, "max": "1", "mustSupport": false }, { "id": "Claim.identifier.id", "path": "Claim.identifier.id", "max": "0" }, { "id": "Claim.identifier.extension", "path": "Claim.identifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" } }, { "id": "Claim.identifier.extension:claim-id", "path": "Claim.identifier.extension", "sliceName": "claim-id", "min": 1, "max": "1", "type": [ { "code": "Extension", "profile": "http://fhir-es.transcendinsights.com/stu3/StructureDefinition/claim-id" } ] }, { "id": "Claim.identifier.extension:claim-line-number", "path": "Claim.identifier.extension", "sliceName": "claim-line-number", "min": 1, "max": "1", "type": [ { "code": "Extension", "profile": "http://fhir-es.transcendinsights.com/stu3/StructureDefinition/claim-line-number" } ] }, { "id": "Claim.identifier.use", "path": "Claim.identifier.use", "max": "0", "fixedCode": "official" }, { "id": "Claim.identifier.type", "path": "Claim.identifier.type", "max": "0" }, { "id": "Claim.identifier.type.id", "path": "Claim.identifier.type.id", "max": "0" }, { "id": "Claim.identifier.type.coding.id", "path": "Claim.identifier.type.coding.id", "max": "0" }, { "id": "Claim.identifier.type.coding.system", "path": "Claim.identifier.type.coding.system", "min": 1 }, { "id": "Claim.identifier.type.coding.version", "path": "Claim.identifier.type.coding.version", "max": "0" }, { "id": "Claim.identifier.type.coding.code", "path": "Claim.identifier.type.coding.code", "min": 1 }, { "id": "Claim.identifier.type.coding.userSelected", "path": "Claim.identifier.type.coding.userSelected", "max": "0" }, { "id": "Claim.identifier.system", "path": "Claim.identifier.system", "min": 1, "fixedUri": "http://fhir-es.transcendinsights.com/stu3/NamingSystem/humana-claim-identifier" }, { "id": "Claim.identifier.value", "path": "Claim.identifier.value", "definition": "The Claim identifier.", "comment": "Concatenate the Claim id value with the delimiter '-LN-' followed by the Claim line number value.", "min": 1, "mapping": [ { "identity": "MEDICAL-CLAIMS", "map": "CLAIM_ID concat delimiter -LN- concat CLAIM_LINE_NUMBER", "comment": "Concatenate the Claim id value with '-LN-' followed by the Claim line number value" } ] }, { "id": "Claim.identifier.period", "path": "Claim.identifier.period", "max": "0" }, { "id": "Claim.identifier.assigner", "path": "Claim.identifier.assigner", "max": "0" }, { "id": "Claim.status", "path": "Claim.status", "short": "active | cancelled | draft", "min": 1, "fixedCode": "active", "mustSupport": false }, { "id": "Claim.type", "path": "Claim.type", "max": "0" }, { "id": "Claim.type.id", "path": "Claim.type.id", "max": "0" }, { "id": "Claim.type.coding", "path": "Claim.type.coding", "min": 1, "max": "1" }, { "id": "Claim.type.coding.id", "path": "Claim.type.coding.id", "max": "0" }, { "id": "Claim.type.coding.system", "path": "Claim.type.coding.system", "min": 1, "fixedUri": "http://hl7.org/fhir/ex-claimtype" }, { "id": "Claim.type.coding.version", "path": "Claim.type.coding.version", "max": "0" }, { "id": "Claim.type.coding.code", "path": "Claim.type.coding.code", "short": "Claim type", "definition": "The type of claim e.g. pharmacy, institutional, professional, etc. See possible values defined in http://hl7.org/fhir/ValueSet/claim-type.", "min": 1 }, { "id": "Claim.type.coding.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.type.coding.display", "max": "0" }, { "id": "Claim.type.coding.userSelected", "path": "Claim.type.coding.userSelected", "max": "0" }, { "id": "Claim.type.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.type.text", "max": "0" }, { "id": "Claim.subType", "path": "Claim.subType", "max": "1" }, { "id": "Claim.subType.coding", "path": "Claim.subType.coding", "min": 1, "max": "1" }, { "id": "Claim.subType.coding.system", "path": "Claim.subType.coding.system", "min": 1, "fixedUri": "http://www.nubc.org/type-of-bill-codes" }, { "id": "Claim.subType.coding.version", "path": "Claim.subType.coding.version", "max": "0" }, { "id": "Claim.subType.coding.code", "path": "Claim.subType.coding.code", "min": 1, "mapping": [ { "identity": "MEDICAL-CLAIMS", "map": "TYPE_OF_BILL" } ] }, { "id": "Claim.subType.coding.userSelected", "path": "Claim.subType.coding.userSelected", "max": "0" }, { "id": "Claim.subType.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.subType.text", "max": "0" }, { "id": "Claim.use", "path": "Claim.use", "short": "complete | exploratory", "definition": "A claim must have a 'use' value equal to 'complete' or 'exploratory'. The exploratory status should only be used when the claim is part of the near-real time request or in the Measure Report, but not in the Patient bundle.", "min": 1, "mustSupport": false }, { "id": "Claim.patient", "path": "Claim.patient", "short": "The patient that this claim belongs to.", "min": 1 }, { "id": "Claim.patient.id", "path": "Claim.patient.id", "max": "0" }, { "id": "Claim.patient.reference", "path": "Claim.patient.reference", "short": "A reference to a location at which the patient resource is found.", "definition": "It is an internal reference that refers to the patient resource. If the patient resource is a contained resource, then the reference must start with '#'.", "min": 1, "example": [ { "label": "Reference to a Patient entry in a bundle", "valueString": "" } ], "mustSupport": true }, { "id": "Claim.patient.identifier", "path": "Claim.patient.identifier", "max": "0" }, { "id": "Claim.patient.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.patient.display", "max": "0" }, { "id": "Claim.billablePeriod", "path": "Claim.billablePeriod", "max": "0" }, { "id": "Claim.created", "path": "Claim.created", "max": "0" }, { "id": "Claim.enterer", "path": "Claim.enterer", "max": "0" }, { "id": "Claim.insurer", "path": "Claim.insurer", "max": "0" }, { "id": "Claim.provider", "path": "Claim.provider", "max": "0" }, { "id": "Claim.organization", "path": "Claim.organization", "short": "Responsible organization (pharmacy)", "definition": "The organization responsible e.g. pharmacy for dispensing the medication.", "max": "0" }, { "id": "Claim.organization.id", "path": "Claim.organization.id", "max": "0" }, { "id": "Claim.organization.reference", "path": "Claim.organization.reference", "short": "Organization reference", "definition": "A reference to the Organization resource.", "max": "0" }, { "id": "Claim.organization.identifier", "path": "Claim.organization.identifier", "max": "0" }, { "id": "Claim.organization.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.organization.display", "max": "0" }, { "id": "Claim.priority", "path": "Claim.priority", "max": "0" }, { "id": "Claim.fundsReserve", "path": "Claim.fundsReserve", "max": "0" }, { "id": "Claim.related", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "RelatedClaim" } ], "path": "Claim.related", "max": "0" }, { "id": "Claim.prescription", "path": "Claim.prescription", "max": "0" }, { "id": "Claim.originalPrescription", "path": "Claim.originalPrescription", "max": "0" }, { "id": "Claim.payee", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Payee" } ], "path": "Claim.payee", "max": "0" }, { "id": "Claim.referral", "path": "Claim.referral", "max": "0" }, { "id": "Claim.facility", "path": "Claim.facility", "max": "0" }, { "id": "Claim.careTeam", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "CareTeam" } ], "path": "Claim.careTeam", "mustSupport": false }, { "id": "Claim.careTeam.id", "path": "Claim.careTeam.id", "max": "0" }, { "id": "Claim.careTeam.sequence", "path": "Claim.careTeam.sequence", "mustSupport": false }, { "id": "Claim.careTeam.provider.id", "path": "Claim.careTeam.provider.id", "max": "0" }, { "id": "Claim.careTeam.provider.reference", "path": "Claim.careTeam.provider.reference", "min": 1, "example": [ { "label": "Reference to a Practitioner entry in a bundle", "valueString": "" } ], "mustSupport": false }, { "id": "Claim.careTeam.provider.identifier", "path": "Claim.careTeam.provider.identifier", "max": "0" }, { "id": "Claim.careTeam.provider.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.careTeam.provider.display", "max": "0" }, { "id": "Claim.careTeam.responsible", "path": "Claim.careTeam.responsible", "max": "0" }, { "id": "Claim.careTeam.role", "path": "Claim.careTeam.role", "max": "0" }, { "id": "Claim.careTeam.role.id", "path": "Claim.careTeam.role.id", "max": "0" }, { "id": "Claim.careTeam.role.coding.id", "path": "Claim.careTeam.role.coding.id", "max": "0" }, { "id": "Claim.careTeam.role.coding.system", "path": "Claim.careTeam.role.coding.system", "min": 1 }, { "id": "Claim.careTeam.role.coding.code", "path": "Claim.careTeam.role.coding.code", "min": 1 }, { "id": "Claim.careTeam.role.coding.userSelected", "path": "Claim.careTeam.role.coding.userSelected", "max": "0" }, { "id": "Claim.careTeam.role.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.careTeam.role.text", "max": "0" }, { "id": "Claim.careTeam.qualification", "path": "Claim.careTeam.qualification", "max": "0" }, { "id": "Claim.careTeam.qualification.id", "path": "Claim.careTeam.qualification.id", "max": "0" }, { "id": "Claim.careTeam.qualification.coding.id", "path": "Claim.careTeam.qualification.coding.id", "max": "0" }, { "id": "Claim.careTeam.qualification.coding.system", "path": "Claim.careTeam.qualification.coding.system", "min": 1 }, { "id": "Claim.careTeam.qualification.coding.code", "path": "Claim.careTeam.qualification.coding.code", "min": 1 }, { "id": "Claim.careTeam.qualification.coding.userSelected", "path": "Claim.careTeam.qualification.coding.userSelected", "max": "0" }, { "id": "Claim.careTeam.qualification.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.careTeam.qualification.text", "max": "0" }, { "id": "Claim.information", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "SpecialCondition" } ], "path": "Claim.information", "definition": "Additional information codes regarding a service in the claim." }, { "id": "Claim.information.id", "path": "Claim.information.id", "max": "0" }, { "id": "Claim.information.sequence", "path": "Claim.information.sequence", "short": "Information instance unique identifier", "mustSupport": false }, { "id": "Claim.information.category", "path": "Claim.information.category", "definition": "The general class of the information supplied.", "mustSupport": false }, { "id": "Claim.information.category.id", "path": "Claim.information.category.id", "max": "0" }, { "id": "Claim.information.category.coding", "path": "Claim.information.category.coding", "min": 1, "max": "1" }, { "id": "Claim.information.category.coding.id", "path": "Claim.information.category.coding.id", "max": "0" }, { "id": "Claim.information.category.coding.system", "path": "Claim.information.category.coding.system", "fixedUri": "http://hl7.org/fhir/claiminformationcategory" }, { "id": "Claim.information.category.coding.version", "path": "Claim.information.category.coding.version", "max": "0" }, { "id": "Claim.information.category.coding.code", "path": "Claim.information.category.coding.code", "fixedCode": "other" }, { "id": "Claim.information.category.coding.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.information.category.coding.display", "max": "0" }, { "id": "Claim.information.category.coding.userSelected", "path": "Claim.information.category.coding.userSelected", "max": "0" }, { "id": "Claim.information.category.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.information.category.text", "max": "0" }, { "id": "Claim.information.code", "path": "Claim.information.code", "slicing": { "discriminator": [ { "type": "value", "path": "text" } ], "rules": "closed" } }, { "id": "Claim.information.code.id", "path": "Claim.information.code.id", "max": "0" }, { "id": "Claim.information.code.coding", "path": "Claim.information.code.coding", "max": "0" }, { "id": "Claim.information.code:ndcCode", "path": "Claim.information.code", "sliceName": "ndcCode" }, { "id": "Claim.information.code:ndcCode.id", "path": "Claim.information.code.id", "max": "0" }, { "id": "Claim.information.code:ndcCode.coding", "path": "Claim.information.code.coding", "max": "0" }, { "id": "Claim.information.code:ndcCode.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.information.code.text", "min": 1, "fixedString": "NDC" }, { "id": "Claim.information.code:unitsCode", "path": "Claim.information.code", "sliceName": "unitsCode" }, { "id": "Claim.information.code:unitsCode.id", "path": "Claim.information.code.id", "max": "0" }, { "id": "Claim.information.code:unitsCode.coding", "path": "Claim.information.code.coding", "max": "0" }, { "id": "Claim.information.code:unitsCode.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.information.code.text", "min": 1, "fixedString": "UNITS" }, { "id": "Claim.information.code:patientStatusCode", "path": "Claim.information.code", "sliceName": "patientStatusCode" }, { "id": "Claim.information.code:patientStatusCode.id", "path": "Claim.information.code.id", "max": "0" }, { "id": "Claim.information.code:patientStatusCode.coding", "path": "Claim.information.code.coding", "max": "0" }, { "id": "Claim.information.code:patientStatusCode.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.information.code.text", "min": 1, "fixedString": "PATIENT_STATUS_CODE" }, { "id": "Claim.information.timing[x]", "path": "Claim.information.timing[x]", "max": "0" }, { "id": "Claim.information.value[x]:valueString", "path": "Claim.information.valueString", "sliceName": "valueString", "definition": "Additional data or information.", "type": [ { "code": "string" } ], "mustSupport": false, "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "NDC", "comment": "Information.code must be equal to NDC. A link is required from Claim.item." }, { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "UNITS", "comment": "Information.code must be equal to UNITS. A link is required from Claim.item." }, { "identity": "MEDICAL-CLAIMS", "map": "PATIENT_STATUS_CODE", "comment": "Information.code must be equal to PATIENT_STATUS_CODE. No link is required from Claim.item." } ] }, { "id": "Claim.information.reason", "path": "Claim.information.reason", "max": "0" }, { "id": "Claim.diagnosis.id", "path": "Claim.diagnosis.id", "max": "0" }, { "id": "Claim.diagnosis.sequence", "path": "Claim.diagnosis.sequence", "short": "unique number to covey order of diagnosis", "definition": "Sequence of diagnosis which serves to provide a link. This in not the claim line number, but a number that associates a diagnosis to a particular service (procedure)." }, { "id": "Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept", "path": "Claim.diagnosis.diagnosisCodeableConcept", "sliceName": "diagnosisCodeableConcept", "type": [ { "code": "CodeableConcept" } ] }, { "id": "Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept.coding", "path": "Claim.diagnosis.diagnosisCodeableConcept.coding", "max": "1" }, { "id": "Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept.coding.system", "path": "Claim.diagnosis.diagnosisCodeableConcept.coding.system", "definition": "For ICD10 Diagnosis codes use: http://hl7.org/fhir/sid/icd-10-cm", "min": 1, "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "CLIN_CODE_TYPE_CODE", "comment": "CLIN_CODE_TYPE_CODE must be equal to ICD10-CM or similar ICD10 Diagnosis code" } ] }, { "id": "Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept.coding.version", "path": "Claim.diagnosis.diagnosisCodeableConcept.coding.version", "max": "0" }, { "id": "Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept.coding.code", "path": "Claim.diagnosis.diagnosisCodeableConcept.coding.code", "min": 1, "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "CLIN_CODE" } ] }, { "id": "Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept.coding.userSelected", "path": "Claim.diagnosis.diagnosisCodeableConcept.coding.userSelected", "max": "0" }, { "id": "Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.diagnosis.diagnosisCodeableConcept.text", "max": "0" }, { "id": "Claim.diagnosis.type", "path": "Claim.diagnosis.type", "max": "0" }, { "id": "Claim.diagnosis.type.id", "path": "Claim.diagnosis.type.id", "max": "0" }, { "id": "Claim.diagnosis.type.coding.id", "path": "Claim.diagnosis.type.coding.id", "max": "0" }, { "id": "Claim.diagnosis.type.coding.system", "path": "Claim.diagnosis.type.coding.system", "min": 1 }, { "id": "Claim.diagnosis.type.coding.code", "path": "Claim.diagnosis.type.coding.code", "min": 1 }, { "id": "Claim.diagnosis.type.coding.userSelected", "path": "Claim.diagnosis.type.coding.userSelected", "max": "0" }, { "id": "Claim.diagnosis.type.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.diagnosis.type.text", "max": "0" }, { "id": "Claim.diagnosis.packageCode.coding", "path": "Claim.diagnosis.packageCode.coding", "min": 1, "max": "1" }, { "id": "Claim.diagnosis.packageCode.coding.system", "path": "Claim.diagnosis.packageCode.coding.system", "min": 1, "fixedUri": "https://www.cms.gov/ms-drg", "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "CLIN_CODE_TYPE_CODE", "comment": "CLIN_CODE_TYPE_CODE must be equal to MSDRG or similar CMS Diagnosis group code" } ] }, { "id": "Claim.diagnosis.packageCode.coding.version", "path": "Claim.diagnosis.packageCode.coding.version", "max": "0" }, { "id": "Claim.diagnosis.packageCode.coding.code", "path": "Claim.diagnosis.packageCode.coding.code", "min": 1, "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "MSDRG_CODE" } ] }, { "id": "Claim.diagnosis.packageCode.coding.userSelected", "path": "Claim.diagnosis.packageCode.coding.userSelected", "max": "0" }, { "id": "Claim.diagnosis.packageCode.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.diagnosis.packageCode.text", "max": "0" }, { "id": "Claim.procedure", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Procedure" } ], "path": "Claim.procedure", "max": "0" }, { "id": "Claim.insurance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Insurance" } ], "path": "Claim.insurance", "max": "0" }, { "id": "Claim.accident", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Accident" } ], "path": "Claim.accident", "max": "0" }, { "id": "Claim.employmentImpacted", "path": "Claim.employmentImpacted", "max": "0" }, { "id": "Claim.hospitalization.start", "path": "Claim.hospitalization.start", "mapping": [ { "identity": "MEDICAL-CLAIMS", "map": "ADMIT_DATE" } ] }, { "id": "Claim.hospitalization.end", "path": "Claim.hospitalization.end", "mapping": [ { "identity": "MEDICAL-CLAIMS", "map": "DISCHARGE_DATE" } ] }, { "id": "Claim.item", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Item" } ], "path": "Claim.item", "definition": "The service provided.", "min": 1, "mustSupport": false }, { "id": "Claim.item.id", "path": "Claim.item.id", "max": "0" }, { "id": "Claim.item.careTeamLinkId", "path": "Claim.item.careTeamLinkId", "short": "Link to the careTeam(Practitioner).", "definition": "The link id to the responsible service provider. The careTeamId value must match one of the values in CareTeam.sequence.", "mustSupport": false }, { "id": "Claim.item.diagnosisLinkId", "path": "Claim.item.diagnosisLinkId", "mustSupport": false }, { "id": "Claim.item.procedureLinkId", "path": "Claim.item.procedureLinkId", "max": "0" }, { "id": "Claim.item.informationLinkId", "path": "Claim.item.informationLinkId", "short": "Links to supporting information of this item.", "definition": "Link identifiers to supporting information for this medical claim such HCPCS units, NDC and patient status code. The informationLinkId value must match one of the values in Information.sequence.", "mustSupport": false }, { "id": "Claim.item.revenue.coding", "path": "Claim.item.revenue.coding", "min": 1, "max": "1" }, { "id": "Claim.item.revenue.coding.system", "path": "Claim.item.revenue.coding.system", "min": 1, "fixedUri": "http://www.nubc.org/revenue-codes", "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "CLIN_CODE_TYPE_CODE", "comment": "CLIN_CODE_TYPE_CODE must be equal to REVCODE or a similar revenue code type." } ] }, { "id": "Claim.item.revenue.coding.version", "path": "Claim.item.revenue.coding.version", "max": "0" }, { "id": "Claim.item.revenue.coding.code", "path": "Claim.item.revenue.coding.code", "short": "Revenue code", "definition": "The revenue code.", "min": 1, "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "CLIN_CODE", "comment": "CLIN_CODE_TYPE must be equal to REVCODE or a similar revenue code type." } ] }, { "id": "Claim.item.revenue.coding.userSelected", "path": "Claim.item.revenue.coding.userSelected", "max": "0" }, { "id": "Claim.item.revenue.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.item.revenue.text", "max": "0" }, { "id": "Claim.item.category", "path": "Claim.item.category", "max": "0" }, { "id": "Claim.item.service", "path": "Claim.item.service", "short": "A service (procedure) that was billed in this claiim.", "definition": "A service or procedure billed in this claim.", "example": [ { "label": "Claim service example", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/sid/icd-10", "code": "0FB03ZX", "display": "Excision of liver, percutaneous approach" } ] } } ], "mustSupport": false }, { "id": "Claim.item.service.id", "path": "Claim.item.service.id", "max": "0" }, { "id": "Claim.item.service.coding", "path": "Claim.item.service.coding", "min": 1, "max": "1" }, { "id": "Claim.item.service.coding.id", "path": "Claim.item.service.coding.id", "max": "0" }, { "id": "Claim.item.service.coding.system", "path": "Claim.item.service.coding.system", "definition": "The identification of the code system that defines the meaning of the symbol in the code. System values include: http://www.ama-assn.org/go/cpt for CPT codes, http://www.icd10data.com/icd10pcs for ICD10 Procedure codes, and urn:oid:2.16.840.1.113883.1.11.19394 for HCPCS codes.", "min": 1, "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "CLIN_CODE_TYPE_CODE", "comment": "CLIN_CODE_TYPE_CODE must be equal CPT, HCPCS, or ICD10 Procedure code." } ] }, { "id": "Claim.item.service.coding.version", "path": "Claim.item.service.coding.version", "max": "0" }, { "id": "Claim.item.service.coding.code", "path": "Claim.item.service.coding.code", "short": "Service/Procedure code value.", "definition": "A code value within the defined system that identifies the service listed in this claim.", "min": 1, "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "CLIN_CODE", "comment": "CLIN_CODE_TYPE must be equal to CPT, ICD10PCS, or HCPCS" } ] }, { "id": "Claim.item.service.coding.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.item.service.coding.display", "definition": "A description of the procedure/service provided." }, { "id": "Claim.item.service.coding.userSelected", "path": "Claim.item.service.coding.userSelected", "max": "0" }, { "id": "Claim.item.service.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.item.service.text", "max": "0" }, { "id": "Claim.item.modifier", "path": "Claim.item.modifier", "max": "1" }, { "id": "Claim.item.modifier.coding", "path": "Claim.item.modifier.coding", "min": 1, "max": "1" }, { "id": "Claim.item.modifier.coding.system", "path": "Claim.item.modifier.coding.system", "definition": "For CPT modifiers, the system is: http://www.ama-assn.org/go/cpt", "min": 1, "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "CLIN_CODE_TYPE_CODE", "comment": "CLIN_CODE_TYPE_CODE muste be equal to a CPT modifier code" } ] }, { "id": "Claim.item.modifier.coding.version", "path": "Claim.item.modifier.coding.version", "max": "0" }, { "id": "Claim.item.modifier.coding.code", "path": "Claim.item.modifier.coding.code", "min": 1, "mapping": [ { "identity": "PATIENT-MED-CLM-CLIN-CODES", "map": "CLIN_CODE_TYPE_MODIFIER" } ] }, { "id": "Claim.item.modifier.coding.userSelected", "path": "Claim.item.modifier.coding.userSelected", "max": "0" }, { "id": "Claim.item.modifier.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.item.modifier.text", "max": "0" }, { "id": "Claim.item.programCode", "path": "Claim.item.programCode", "max": "0" }, { "id": "Claim.item.serviced[x]:servicedDate", "path": "Claim.item.servicedDate", "sliceName": "servicedDate", "definition": "The date when the service/procedure was performed.", "min": 1, "type": [ { "code": "date" } ], "mustSupport": false, "mapping": [ { "identity": "MEDICAL-CLAIMS", "map": "SERVICE_DATE" } ] }, { "id": "Claim.item.location[x]:locationCodeableConcept", "path": "Claim.item.locationCodeableConcept", "sliceName": "locationCodeableConcept", "type": [ { "code": "CodeableConcept" } ] }, { "id": "Claim.item.location[x]:locationCodeableConcept.coding", "path": "Claim.item.locationCodeableConcept.coding", "min": 1, "max": "1" }, { "id": "Claim.item.location[x]:locationCodeableConcept.coding.system", "path": "Claim.item.locationCodeableConcept.coding.system", "min": 1, "fixedUri": "https://www.cms.gov/Medicare/Coding/place-of-service-codes" }, { "id": "Claim.item.location[x]:locationCodeableConcept.coding.version", "path": "Claim.item.locationCodeableConcept.coding.version", "max": "0" }, { "id": "Claim.item.location[x]:locationCodeableConcept.coding.code", "path": "Claim.item.locationCodeableConcept.coding.code", "short": "Place of service", "definition": "Place of service code", "min": 1, "mapping": [ { "identity": "MEDICAL-CLAIMS", "map": "PLACE_OF_SERVICE_CODE" } ] }, { "id": "Claim.item.location[x]:locationCodeableConcept.coding.userSelected", "path": "Claim.item.locationCodeableConcept.coding.userSelected", "max": "0" }, { "id": "Claim.item.location[x]:locationCodeableConcept.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Claim.item.locationCodeableConcept.text", "max": "0" }, { "id": "Claim.item.quantity:quantity", "path": "Claim.item.quantity", "sliceName": "quantity", "max": "0", "mustSupport": false }, { "id": "Claim.item.quantity:quantity.id", "path": "Claim.item.quantity.id", "max": "0" }, { "id": "Claim.item.quantity:quantity.value", "path": "Claim.item.quantity.value", "definition": "The value of quantity dispensed." }, { "id": "Claim.item.quantity:quantity.system", "path": "Claim.item.quantity.system", "fixedUri": "http://unitsofmeasure.org" }, { "id": "Claim.item.quantity:quantity.code", "path": "Claim.item.quantity.code", "definition": "A computer processable form of the unit definied in http://unitsofmeasure.org e.g. TAB" }, { "id": "Claim.item.unitPrice", "path": "Claim.item.unitPrice", "max": "0" }, { "id": "Claim.item.factor", "path": "Claim.item.factor", "max": "0" }, { "id": "Claim.item.net", "path": "Claim.item.net", "max": "0" }, { "id": "Claim.item.udi", "path": "Claim.item.udi", "max": "0" }, { "id": "Claim.item.bodySite", "path": "Claim.item.bodySite", "max": "0" }, { "id": "Claim.item.subSite", "path": "Claim.item.subSite", "max": "0" }, { "id": "Claim.item.encounter", "path": "Claim.item.encounter", "max": "0" }, { "id": "Claim.item.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Detail" } ], "path": "Claim.item.detail", "max": "0" }, { "id": "Claim.total", "path": "Claim.total", "max": "0" } ] } }