{ "resourceType": "StructureDefinition", "id": "Claim", "meta": { "lastUpdated": "2017-04-18T21:44:43.294+00:00" }, "text": { "status": "generated", "div": "
NameFlagsCard.TypeDescription & Constraints\"doco\"
\".\"\".\"ClaimDomainResourceClaim, Pre-determination or Pre-authorization\n
Elements defined in Ancestors: \n id, \n meta, \n implicitRules, \n language, \n text, \n contained, \n extension, \n modifierExtension
\".\"\".\"\".\"identifier0..*IdentifierClaim number\n
\".\"\".\"\".\"status?!Σ0..1codeactive | cancelled | draft | entered-in-error\n
Financial Resource Status Codes (\n Required)\n
\".\"\".\"\".\"type0..1CodeableConceptType or discipline\n
Example Claim Type Codes (\n Required)\n
\".\"\".\"\".\"subType0..*CodeableConceptFiner grained claim type information\n
Example Claim SubType Codes (\n Example)\n
\".\"\".\"\".\"use0..1codecomplete | proposed | exploratory | other\n
Use (\n Required)\n
\".\"\".\"\".\"patient0..1Reference(\n Patient)\n The subject of the Products and Services
\".\"\".\"\".\"billablePeriod0..1PeriodPeriod for charge submission
\".\"\".\"\".\"created0..1dateTimeCreation date
\".\"\".\"\".\"enterer0..1Reference(\n Practitioner)\n Author
\".\"\".\"\".\"insurer0..1Reference(\n Organization)\n Target
\".\"\".\"\".\"provider0..1Reference(\n Practitioner)\n Responsible provider
\".\"\".\"\".\"organization0..1Reference(\n Organization)\n Responsible organization
\".\"\".\"\".\"priority0..1CodeableConceptDesired processing priority\n
Process Priority Codes (\n Example)\n
\".\"\".\"\".\"fundsReserve0..1CodeableConceptFunds requested to be reserved\n
Funds Reservation Codes (\n Example)\n
\".\"\".\"\".\"related0..*BackboneElementRelated Claims which may be revelant to processing this claimn\n
\".\"\".\"\".\"\".\"claim0..1Reference(\n Claim)\n Reference to the related claim
\".\"\".\"\".\"\".\"relationship0..1CodeableConceptHow the reference claim is related\n
Example Related Claim Relationship Codes (\n Example)\n
\".\"\".\"\".\"\".\"reference0..1IdentifierRelated file or case reference
\".\"\".\"\".\"prescription0..1Reference(\n MedicationRequest | \n VisionPrescription)\n Prescription authorizing services or products
\".\"\".\"\".\"originalPrescription0..1Reference(\n MedicationRequest)\n Original prescription if superceded by fulfiller
\".\"\".\"\".\"payee0..1BackboneElementParty to be paid any benefits payable
\".\"\".\"\".\"\".\"type1..1CodeableConceptType of party: Subscriber, Provider, other\n
Claim Payee Type Codes (\n Example)\n
\".\"\".\"\".\"\".\"resourceType0..1Codingorganization | patient | practitioner | relatedperson\n
ClaimPayeeResourceType (\n Example)\n
\".\"\".\"\".\"\".\"party0..1Reference(\n Practitioner | \n Organization | \n Patient | \n RelatedPerson)\n Party to receive the payable
\".\"\".\"\".\"referral0..1Reference(\n ReferralRequest)\n Treatment Referral
\".\"\".\"\".\"facility0..1Reference(\n Location)\n Servicing Facility
\".\"\".\"\".\"careTeam0..*BackboneElementMembers of the care team\n
\".\"\".\"\".\"\".\"sequence1..1positiveIntNumber to covey order of careTeam
\".\"\".\"\".\"\".\"provider1..1Reference(\n Practitioner | \n Organization)\n Provider individual or organization
\".\"\".\"\".\"\".\"responsible0..1booleanBilling provider
\".\"\".\"\".\"\".\"role0..1CodeableConceptRole on the team\n
Claim Care Team Role Codes (\n Example)\n
\".\"\".\"\".\"\".\"qualification0..1CodeableConceptType, classification or Specialization\n
Example Provider Qualification Codes (\n Example)\n
\".\"\".\"\".\"information0..*BackboneElementExceptions, special considerations, the condition, situation, prior or concurrent issues\n
\".\"\".\"\".\"\".\"sequence1..1positiveIntInformation instance identifier
\".\"\".\"\".\"\".\"category1..1CodeableConceptGeneral class of information\n
Claim Information Category Codes (\n Example)\n
\".\"\".\"\".\"\".\"code0..1CodeableConceptType of information\n
Exception Codes (\n Example)\n
\".\"\".\"\".\"\".\"timing[x]0..1When it occurred
\".\"\".\"\".\"\".\"\".\"timingDatedate
\".\"\".\"\".\"\".\"\".\"timingPeriodPeriod
\".\"\".\"\".\"\".\"value[x]0..1Additional Data or supporting information
\".\"\".\"\".\"\".\"\".\"valueStringstring
\".\"\".\"\".\"\".\"\".\"valueQuantityQuantity
\".\"\".\"\".\"\".\"\".\"valueAttachmentAttachment
\".\"\".\"\".\"\".\"\".\" valueReference\n Reference(\n Any)\n
\".\"\".\"\".\"\".\"reason0..1CodeableConceptReason associated with the information\n
Missing Tooth Reason Codes (\n Example)\n
\".\"\".\"\".\"diagnosis0..*BackboneElementList of Diagnosis\n
\".\"\".\"\".\"\".\"sequence1..1positiveIntNumber to covey order of diagnosis
\".\"\".\"\".\"\".\"diagnosis[x]1..1Patient's diagnosis\n
ICD-10 Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"diagnosisCodeableConceptCodeableConcept
\".\"\".\"\".\"\".\"\".\" diagnosisReference\n Reference(\n Condition)\n
\".\"\".\"\".\"\".\"type0..*CodeableConceptTiming or nature of the diagnosis\n
Example Diagnosis Type Codes (\n Example)\n
\".\"\".\"\".\"\".\"packageCode0..1CodeableConceptPackage billing code\n
Example Diagnosis Related Group Codes (\n Example)\n
\".\"\".\"\".\"procedure0..*BackboneElementProcedures performed\n
\".\"\".\"\".\"\".\"sequence1..1positiveIntProcedure sequence for reference
\".\"\".\"\".\"\".\"date0..1dateTimeWhen the procedure was performed
\".\"\".\"\".\"\".\"procedure[x]1..1Patient's list of procedures performed\n
ICD-10 Procedure Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"procedureCodeableConceptCodeableConcept
\".\"\".\"\".\"\".\"\".\" procedureReference\n Reference(\n Procedure)\n
\".\"\".\"\".\"insurance0..*BackboneElementInsurance or medical plan\n
\".\"\".\"\".\"\".\"sequence1..1positiveIntService instance identifier
\".\"\".\"\".\"\".\"focal1..1booleanIs the focal Coverage
\".\"\".\"\".\"\".\"coverage1..1Reference(\n Coverage)\n Insurance information
\".\"\".\"\".\"\".\"businessArrangement0..1stringBusiness agreement
\".\"\".\"\".\"\".\"preAuthRef0..*stringPre-Authorization/Determination Reference\n
\".\"\".\"\".\"\".\"claimResponse0..1Reference(\n ClaimResponse)\n Adjudication results
\".\"\".\"\".\"accident0..1BackboneElementDetails about an accident
\".\"\".\"\".\"\".\"date1..1dateWhen the accident occurred\nsee information codes\nsee information codes
\".\"\".\"\".\"\".\"type0..1CodeableConceptThe nature of the accident\n
ActIncidentCode (\n Required)\n
\".\"\".\"\".\"\".\"location[x]0..1Accident Place
\".\"\".\"\".\"\".\"\".\" locationAddress\n Address
\".\"\".\"\".\"\".\"\".\" locationReference\n Reference(\n Location)\n
\".\"\".\"\".\"employmentImpacted0..1PeriodPeriod unable to work
\".\"\".\"\".\"hospitalization0..1PeriodPeriod in hospital
\".\"\".\"\".\"item0..*BackboneElementGoods and Services\n
\".\"\".\"\".\"\".\"sequence1..1positiveIntService instance
\".\"\".\"\".\"\".\"careTeamLinkId0..*positiveIntApplicable careTeam members\n
\".\"\".\"\".\"\".\"diagnosisLinkId0..*positiveIntApplicable diagnoses\n
\".\"\".\"\".\"\".\"procedureLinkId0..*positiveIntApplicable procedures\n
\".\"\".\"\".\"\".\"informationLinkId0..*positiveIntApplicable exception and supporting information\n
\".\"\".\"\".\"\".\"revenue0..1CodeableConceptRevenue or cost center code\n
Example Revenue Center Codes (\n Example)\n
\".\"\".\"\".\"\".\"category0..1CodeableConceptType of service or product\n
Benefit SubCategory Codes (\n Example)\n
\".\"\".\"\".\"\".\"service0..1CodeableConceptBilling Code\n
USCLS Codes (\n Example)\n
\".\"\".\"\".\"\".\"modifier0..*CodeableConceptService/Product billing modifiers\n
Modifier type Codes (\n Example)\n
\".\"\".\"\".\"\".\"programCode0..*CodeableConceptProgram specific reason for item inclusion\n
Example Program Reason Codes (\n Example)\n
\".\"\".\"\".\"\".\"serviced[x]0..1Date or dates of Service
\".\"\".\"\".\"\".\"\".\"servicedDatedate
\".\"\".\"\".\"\".\"\".\"servicedPeriodPeriod
\".\"\".\"\".\"\".\"location[x]0..1Place of service\n
Example Service Place Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"locationCodeableConceptCodeableConcept
\".\"\".\"\".\"\".\"\".\" locationAddress\n Address
\".\"\".\"\".\"\".\"\".\" locationReference\n Reference(\n Location)\n
\".\"\".\"\".\"\".\"quantity0..1SimpleQuantityCount of Products or Services
\".\"\".\"\".\"\".\"unitPrice0..1MoneyFee, charge or cost per point
\".\"\".\"\".\"\".\"factor0..1decimalPrice scaling factor
\".\"\".\"\".\"\".\"net0..1MoneyTotal item cost
\".\"\".\"\".\"\".\"udi0..*Reference(\n Device)\n Unique Device Identifier\n
\".\"\".\"\".\"\".\"bodySite0..1CodeableConceptService Location\n
Oral Site Codes (\n Example)\n
\".\"\".\"\".\"\".\"subSite0..*CodeableConceptService Sub-location\n
Surface Codes (\n Example)\n
\".\"\".\"\".\"\".\"encounter0..*Reference(\n Encounter)\n Encounters related to this billed item\n
\".\"\".\"\".\"\".\"detail0..*BackboneElementAdditional items\n
\".\"\".\"\".\"\".\"\".\"sequence1..1positiveIntService instance
\".\"\".\"\".\"\".\"\".\"revenue0..1CodeableConceptRevenue or cost center code\n
Example Revenue Center Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"category0..1CodeableConceptType of service or product\n
Benefit SubCategory Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"service0..1CodeableConceptBilling Code\n
USCLS Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"modifier0..*CodeableConceptService/Product billing modifiers\n
Modifier type Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"programCode0..*CodeableConceptProgram specific reason for item inclusion\n
Example Program Reason Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"quantity0..1SimpleQuantityCount of Products or Services
\".\"\".\"\".\"\".\"\".\"unitPrice0..1MoneyFee, charge or cost per point
\".\"\".\"\".\"\".\"\".\"factor0..1decimalPrice scaling factor
\".\"\".\"\".\"\".\"\".\"net0..1MoneyTotal additional item cost
\".\"\".\"\".\"\".\"\".\"udi0..*Reference(\n Device)\n Unique Device Identifier\n
\".\"\".\"\".\"\".\"\".\"subDetail0..*BackboneElementAdditional items\n
\".\"\".\"\".\"\".\"\".\"\".\"sequence1..1positiveIntService instance
\".\"\".\"\".\"\".\"\".\"\".\"revenue0..1CodeableConceptRevenue or cost center code\n
Example Revenue Center Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"\".\"category0..1CodeableConceptType of service or product\n
Benefit SubCategory Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"\".\"service0..1CodeableConceptBilling Code\n
USCLS Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"\".\"modifier0..*CodeableConceptService/Product billing modifiers\n
Modifier type Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"\".\"programCode0..*CodeableConceptProgram specific reason for item inclusion\n
Example Program Reason Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"\".\"quantity0..1SimpleQuantityCount of Products or Services
\".\"\".\"\".\"\".\"\".\"\".\"unitPrice0..1MoneyFee, charge or cost per point
\".\"\".\"\".\"\".\"\".\"\".\"factor0..1decimalPrice scaling factor
\".\"\".\"\".\"\".\"\".\"\".\"net0..1MoneyNet additional item cost
\".\"\".\"\".\"\".\"\".\"\".\"udi0..*Reference(\n Device)\n Unique Device Identifier\n
\".\"\".\"\".\"total0..1MoneyTotal claim cost

\"doco\" Documentation for this format\n
" }, "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger": 2 }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode": "fm" } ], "url": "http://hl7.org/fhir/StructureDefinition/Claim", "name": "Claim", "status": "draft", "date": "2017-04-18T21:44:43+00:00", "publisher": "Health Level Seven International (Financial Management)", "contact": [ { "telecom": [ { "system": "url", "value": "http://hl7.org/fhir" } ] }, { "telecom": [ { "system": "url", "value": "http://www.hl7.org/Special/committees/fm/index.cfm" } ] } ], "description": "Base StructureDefinition for Claim Resource", "fhirVersion": "3.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/w5", "name": "W5 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "resource", "abstract": false, "type": "Claim", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource", "derivation": "specialization", "snapshot": { "element": [ { "id": "Claim", "path": "Claim", "short": "Claim, Pre-determination or Pre-authorization", "definition": "A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.", "min": 0, "max": "*", "base": { "path": "Resource", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-1", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain any narrative", "expression": "contained.text.empty()", "xpath": "not(parent::f:contained and f:text)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource", "expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()", "xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "workflow", "map": "Request" }, { "identity": "w5", "map": "financial.billing" } ] }, { "id": "Claim.id", "path": "Claim.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "code": "id" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.meta", "path": "Claim.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.implicitRules", "path": "Claim.implicitRules", "short": "A set of rules under which this content was created", "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.", "comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.language", "path": "Claim.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueReference": { "reference": "http://hl7.org/fhir/ValueSet/all-languages" } }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "extensible", "description": "A human language.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/languages" } }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.text", "path": "Claim.text", "short": "Text summary of the resource, for human interpretation", "definition": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded in formation is added later.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "condition": [ "ele-1", "dom-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Act.text?" } ] }, { "id": "Claim.contained", "path": "Claim.contained", "short": "Contained, inline Resources", "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.extension", "path": "Claim.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.modifierExtension", "path": "Claim.modifierExtension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.identifier", "path": "Claim.identifier", "short": "Claim number", "definition": "The business identifier for the instance: claim number, pre-determination or pre-authorization number.", "min": 0, "max": "*", "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "workflow", "map": "Request.identifier" }, { "identity": "w5", "map": "id" } ] }, { "id": "Claim.status", "path": "Claim.status", "short": "active | cancelled | draft | entered-in-error", "definition": "The status of the resource instance.", "comment": "This element is labeled as a modifier because the status contains the code entered-in-error that marks the claim as not currently valid.", "min": 0, "max": "1", "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isModifier": true, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimStatus" } ], "strength": "required", "description": "A code specifying the state of the resource instance.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fm-status" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Request.status" }, { "identity": "w5", "map": "status" } ] }, { "id": "Claim.type", "path": "Claim.type", "short": "Type or discipline", "definition": "The category of claim, eg, oral, pharmacy, vision, insitutional, professional.", "comment": "Affects which fields and value sets are used.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimType" } ], "strength": "required", "description": "The type or discipline-style of the claim", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-type" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "class" } ] }, { "id": "Claim.subType", "path": "Claim.subType", "short": "Finer grained claim type information", "definition": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.", "comment": "This may contain the local bill type codes such as the US UB-04 bill type code.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimSubType" } ], "strength": "example", "description": "A more granular claim typecode", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-subtype" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "class" } ] }, { "id": "Claim.use", "path": "Claim.use", "short": "complete | proposed | exploratory | other", "definition": "Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Use" } ], "strength": "required", "description": "Complete, proposed, exploratory, other", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-use" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "class" } ] }, { "id": "Claim.patient", "path": "Claim.patient", "short": "The subject of the Products and Services", "definition": "Patient Resource.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Request.subject" }, { "identity": "w5", "map": "who.focus" } ] }, { "id": "Claim.billablePeriod", "path": "Claim.billablePeriod", "short": "Period for charge submission", "definition": "The billable period for which charges are being submitted.", "comment": "This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. 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\"). If duration is required, specify the type as Interval|Duration.", "min": 0, "max": "1", "type": [ { "code": "Period" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Period" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower value than end", "expression": "start.empty() or end.empty() or (start <= end)", "xpath": "not(exists(f:start)) or not(exists(f:end)) or (f:start/@value <= f:end/@value)", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" }, { "identity": "w5", "map": "when.done" } ] }, { "id": "Claim.created", "path": "Claim.created", "short": "Creation date", "definition": "The date when the enclosed suite of services were performed or completed.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Request.authoredOn" }, { "identity": "w5", "map": "when.recorded" } ] }, { "id": "Claim.enterer", "path": "Claim.enterer", "short": "Author", "definition": "Person who created the invoice/claim/pre-determination or pre-authorization.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "who.author" } ] }, { "id": "Claim.insurer", "path": "Claim.insurer", "short": "Target", "definition": "The Insurer who is target of the request.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Request.performer" } ] }, { "id": "Claim.provider", "path": "Claim.provider", "short": "Responsible provider", "definition": "The provider which is responsible for the bill, claim pre-determination, pre-authorization.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Request.requester.agent" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "Claim.organization", "path": "Claim.organization", "short": "Responsible organization", "definition": "The organization which is responsible for the bill, claim pre-determination, pre-authorization.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Request.requester.onBehalfOf" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "Claim.priority", "path": "Claim.priority", "short": "Desired processing priority", "definition": "Immediate (STAT), best effort (NORMAL), deferred (DEFER).", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProcessPriority" } ], "strength": "example", "description": "The timeliness with which processing is required: STAT, normal, Deferred", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/process-priority" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "workflow", "map": "Request.priority" } ] }, { "id": "Claim.fundsReserve", "path": "Claim.fundsReserve", "short": "Funds requested to be reserved", "definition": "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.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "FundsReserve" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "For whom funds are to be reserved: (Patient, Provider, None).", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fundsreserve" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.related", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "RelatedClaim" } ], "path": "Claim.related", "short": "Related Claims which may be revelant to processing this claimn", "definition": "Other claims which are related to this claim such as prior claim versions or for related services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.related.id", "path": "Claim.related.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.related.extension", "path": "Claim.related.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.related.modifierExtension", "path": "Claim.related.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.related.claim", "path": "Claim.related.claim", "short": "Reference to the related claim", "definition": "Other claims which are related to this claim such as prior claim versions or for related services.", "comment": "Do we need a relationship code?", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Claim" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Request.replaces" } ] }, { "id": "Claim.related.relationship", "path": "Claim.related.relationship", "short": "How the reference claim is related", "definition": "For example prior or umbrella.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RelatedClaimRelationship" } ], "strength": "example", "description": "Relationship of this claim to a related Claim", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/related-claim-relationship" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.related.reference", "path": "Claim.related.reference", "short": "Related file or case reference", "definition": "An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # .", "min": 0, "max": "1", "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "Claim.prescription", "path": "Claim.prescription", "short": "Prescription authorizing services or products", "definition": "Prescription to support the dispensing of Pharmacy or Vision products.", "comment": "Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence.", "requirements": "For type=Pharmacy and Vision only.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/MedicationRequest" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/VisionPrescription" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Claim.originalPrescription", "path": "Claim.originalPrescription", "short": "Original prescription if superceded by fulfiller", "definition": "Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.", "comment": "as above.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/MedicationRequest" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Claim.payee", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Payee" } ], "path": "Claim.payee", "short": "Party to be paid any benefits payable", "definition": "The party to be reimbursed for the services.", "min": 0, "max": "1", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.payee.id", "path": "Claim.payee.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.payee.extension", "path": "Claim.payee.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.payee.modifierExtension", "path": "Claim.payee.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.payee.type", "path": "Claim.payee.type", "short": "Type of party: Subscriber, Provider, other", "definition": "Type of Party to be reimbursed: Subscriber, provider, other.", "comment": "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.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PayeeType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "A code for the party to be reimbursed.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/payeetype" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.payee.resourceType", "path": "Claim.payee.resourceType", "short": "organization | patient | practitioner | relatedperson", "definition": "organization | patient | practitioner | relatedperson.", "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.", "min": 0, "max": "1", "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimPayeeResourceType" } ], "strength": "example", "description": "The type of Claim payee Resource", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-payee-resource-type" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" } ] }, { "id": "Claim.payee.party", "path": "Claim.payee.party", "short": "Party to receive the payable", "definition": "Party to be reimbursed: Subscriber, provider, other.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Claim.referral", "path": "Claim.referral", "short": "Treatment Referral", "definition": "The referral resource which lists the date, practitioner, reason and other supporting information.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/ReferralRequest" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "who.cause" } ] }, { "id": "Claim.facility", "path": "Claim.facility", "short": "Servicing Facility", "definition": "Facility where the services were provided.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Location" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "where" } ] }, { "id": "Claim.careTeam", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "CareTeam" } ], "path": "Claim.careTeam", "short": "Members of the care team", "definition": "The members of the team who provided the overall service as well as their role and whether responsible and qualifications.", "requirements": "Role and Responsible may not be required when there is only a single provider listed.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.careTeam.id", "path": "Claim.careTeam.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.careTeam.extension", "path": "Claim.careTeam.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.careTeam.modifierExtension", "path": "Claim.careTeam.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.careTeam.sequence", "path": "Claim.careTeam.sequence", "short": "Number to covey order of careTeam", "definition": "Sequence of the careTeam which serves to order and provide a link.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Required to maintain order of the careTeam.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.careTeam.provider", "path": "Claim.careTeam.provider", "short": "Provider individual or organization", "definition": "Member of the team who provided the overall service.", "comment": "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.", "min": 1, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "who.actor" } ] }, { "id": "Claim.careTeam.responsible", "path": "Claim.careTeam.responsible", "short": "Billing provider", "definition": "The party who is billing and responsible for the claimed good or service rendered to the patient.", "min": 0, "max": "1", "type": [ { "code": "boolean" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.careTeam.role", "path": "Claim.careTeam.role", "short": "Role on the team", "definition": "The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CareTeamRole" } ], "strength": "example", "description": "The role codes for the care team members.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-careteamrole" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.careTeam.qualification", "path": "Claim.careTeam.qualification", "short": "Type, classification or Specialization", "definition": "The qualification which is applicable for this service.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProviderQualification" } ], "strength": "example", "description": "Provider professional qualifications", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/provider-qualification" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.information", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "SpecialCondition" } ], "path": "Claim.information", "short": "Exceptions, special considerations, the condition, situation, prior or concurrent issues", "definition": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.", "requirements": "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Request.supportingInfo" } ] }, { "id": "Claim.information.id", "path": "Claim.information.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.information.extension", "path": "Claim.information.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.information.modifierExtension", "path": "Claim.information.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.information.sequence", "path": "Claim.information.sequence", "short": "Information instance identifier", "definition": "Sequence of the information element which serves to provide a link.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "To provide a reference link.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.information.category", "path": "Claim.information.category", "short": "General class of information", "definition": "The general class of the information supplied: information; exception; accident, employment; onset, etc.", "comment": "This may contain the local bill type codes such as the US UB-04 bill type code.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "InformationCategory" } ], "strength": "example", "description": "The valuset used for additional information category codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-informationcategory" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.information.code", "path": "Claim.information.code", "short": "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 which may influence the adjudication.", "comment": "This may contain the local bill type codes such as the US UB-04 bill type code.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "InformationCode" } ], "strength": "example", "description": "The valuset used for additional information codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-exception" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.information.timing[x]", "path": "Claim.information.timing[x]", "short": "When it occurred", "definition": "The date when or period to which this information refers.", "min": 0, "max": "1", "type": [ { "code": "date" }, { "code": "Period" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.information.value[x]", "path": "Claim.information.value[x]", "short": "Additional Data or supporting information", "definition": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.", "min": 0, "max": "1", "type": [ { "code": "string" }, { "code": "Quantity" }, { "code": "Attachment" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.information.reason", "path": "Claim.information.reason", "short": "Reason associated with the information", "definition": "For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MissingReason" } ], "strength": "example", "description": "Reason codes for the missing teeth", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/missing-tooth-reason" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.diagnosis", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Diagnosis" } ], "path": "Claim.diagnosis", "short": "List of Diagnosis", "definition": "List of patient diagnosis for which care is sought.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Request.reasonReference" } ] }, { "id": "Claim.diagnosis.id", "path": "Claim.diagnosis.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.diagnosis.extension", "path": "Claim.diagnosis.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.diagnosis.modifierExtension", "path": "Claim.diagnosis.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.diagnosis.sequence", "path": "Claim.diagnosis.sequence", "short": "Number to covey order of diagnosis", "definition": "Sequence of diagnosis which serves to provide a link.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Required to allow line items to reference the diagnoses.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.diagnosis.diagnosis[x]", "path": "Claim.diagnosis.diagnosis[x]", "short": "Patient's diagnosis", "definition": "The diagnosis.", "requirements": "Required to adjudicate services rendered to condition presented.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Condition" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ICD10" } ], "strength": "example", "description": "ICD10 Diagnostic codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/icd-10" } }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.diagnosis.type", "path": "Claim.diagnosis.type", "short": "Timing or nature of the diagnosis", "definition": "The type of the Diagnosis, for example: admitting, primary, secondary, discharge.", "comment": "Diagnosis are presented in list order to their expected importance: primary, secondary, etc.", "requirements": "May be required to adjudicate services rendered.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DiagnosisType" } ], "strength": "example", "description": "The type of the diagnosis: admitting, principal, discharge", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-diagnosistype" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.diagnosis.packageCode", "path": "Claim.diagnosis.packageCode", "short": "Package billing code", "definition": "The package billing code, for example DRG, based on the assigned grouping code system.", "comment": "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.", "requirements": "May be required to adjudicate services rendered to the mandated grouping system.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DiagnosisRelatedGroup" } ], "strength": "example", "description": "The DRG codes associated with the diagnosis", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.procedure", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Procedure" } ], "path": "Claim.procedure", "short": "Procedures performed", "definition": "Ordered list of patient procedures performed to support the adjudication.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.procedure.id", "path": "Claim.procedure.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.procedure.extension", "path": "Claim.procedure.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.procedure.modifierExtension", "path": "Claim.procedure.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.procedure.sequence", "path": "Claim.procedure.sequence", "short": "Procedure sequence for reference", "definition": "Sequence of procedures which serves to order and provide a link.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Required to maintain order of the procudures.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.procedure.date", "path": "Claim.procedure.date", "short": "When the procedure was performed", "definition": "Date and optionally time the procedure was performed .", "comment": "SB DateTime??", "requirements": "Required to adjudicate services rendered.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.procedure.procedure[x]", "path": "Claim.procedure.procedure[x]", "short": "Patient's list of procedures performed", "definition": "The procedure code.", "requirements": "Required to adjudicate services rendered.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Procedure" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ICD10_Procedures" } ], "strength": "example", "description": "ICD10 Procedure codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/icd-10-procedures" } }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.insurance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Insurance" } ], "path": "Claim.insurance", "short": "Insurance or medical plan", "definition": "Financial instrument by which payment information for health care.", "requirements": "Health care programs and insurers are significant payors of health service costs.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Coverage" } ] }, { "id": "Claim.insurance.id", "path": "Claim.insurance.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.insurance.extension", "path": "Claim.insurance.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.insurance.modifierExtension", "path": "Claim.insurance.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.insurance.sequence", "path": "Claim.insurance.sequence", "short": "Service instance identifier", "definition": "Sequence of coverage which serves to provide a link and convey coordination of benefit order.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "To maintain order of the coverages.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.insurance.focal", "path": "Claim.insurance.focal", "short": "Is the focal Coverage", "definition": "A flag to indicate that this Coverage is the focus for adjudication. The Coverage against which the claim is to be adjudicated.", "requirements": "To identify which coverage is being adjudicated.", "min": 1, "max": "1", "type": [ { "code": "boolean" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.insurance.coverage", "path": "Claim.insurance.coverage", "short": "Insurance information", "definition": "Reference to the program or plan identification, underwriter or payor.", "comment": "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.", "requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.", "min": 1, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Coverage" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Claim.insurance.businessArrangement", "path": "Claim.insurance.businessArrangement", "short": "Business agreement", "definition": "The contract number of a business agreement which describes the terms and conditions.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.insurance.preAuthRef", "path": "Claim.insurance.preAuthRef", "short": "Pre-Authorization/Determination Reference", "definition": "A list of references from the Insurer to which these services pertain.", "comment": "Note that FHIR strings may not exceed 1MB in size", "requirements": "To provide any pre=determination or prior authorization reference.", "min": 0, "max": "*", "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.insurance.claimResponse", "path": "Claim.insurance.claimResponse", "short": "Adjudication results", "definition": "The Coverages adjudication details.", "comment": "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.", "requirements": "Used by downstream payers to determine what balance remains and the net payable.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/ClaimResponse" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Claim.accident", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Accident" } ], "path": "Claim.accident", "short": "Details about an accident", "definition": "An accident which resulted in the need for healthcare services.", "min": 0, "max": "1", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.accident.id", "path": "Claim.accident.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.accident.extension", "path": "Claim.accident.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.accident.modifierExtension", "path": "Claim.accident.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.accident.date", "path": "Claim.accident.date", "short": "When the accident occurred\nsee information codes\nsee information codes", "definition": "Date of an accident which these services are addressing.", "requirements": "Coverage may be dependant on accidents.", "min": 1, "max": "1", "type": [ { "code": "date" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.accident.type", "path": "Claim.accident.type", "short": "The nature of the accident", "definition": "Type of accident: work, auto, etc.", "comment": "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.", "requirements": "Coverage may be dependant on the type of accident.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AccidentType" } ], "strength": "required", "description": "Type of accident: work place, auto, etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/v3-ActIncidentCode" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.accident.location[x]", "path": "Claim.accident.location[x]", "short": "Accident Place", "definition": "Accident Place.", "min": 0, "max": "1", "type": [ { "code": "Address" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Location" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.employmentImpacted", "path": "Claim.employmentImpacted", "short": "Period unable to work", "definition": "The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).", "comment": "This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. 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\"). If duration is required, specify the type as Interval|Duration.", "min": 0, "max": "1", "type": [ { "code": "Period" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Period" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower value than end", "expression": "start.empty() or end.empty() or (start <= end)", "xpath": "not(exists(f:start)) or not(exists(f:end)) or (f:start/@value <= f:end/@value)", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" } ] }, { "id": "Claim.hospitalization", "path": "Claim.hospitalization", "short": "Period in hospital", "definition": "The start and optional end dates of when the patient was confined to a treatment center.", "comment": "This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. 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\"). If duration is required, specify the type as Interval|Duration.", "min": 0, "max": "1", "type": [ { "code": "Period" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Period" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower value than end", "expression": "start.empty() or end.empty() or (start <= end)", "xpath": "not(exists(f:start)) or not(exists(f:end)) or (f:start/@value <= f:end/@value)", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" } ] }, { "id": "Claim.item", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Item" } ], "path": "Claim.item", "short": "Goods and Services", "definition": "First tier of goods and services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.id", "path": "Claim.item.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.extension", "path": "Claim.item.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.item.modifierExtension", "path": "Claim.item.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.item.sequence", "path": "Claim.item.sequence", "short": "Service instance", "definition": "A service line number.", "comment": "32 bit number; for values larger than this, use decimal", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.careTeamLinkId", "path": "Claim.item.careTeamLinkId", "short": "Applicable careTeam members", "definition": "CareTeam applicable for this service or product line.", "comment": "32 bit number; for values larger than this, use decimal", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.diagnosisLinkId", "path": "Claim.item.diagnosisLinkId", "short": "Applicable diagnoses", "definition": "Diagnosis applicable for this service or product line.", "comment": "32 bit number; for values larger than this, use decimal", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.procedureLinkId", "path": "Claim.item.procedureLinkId", "short": "Applicable procedures", "definition": "Procedures applicable for this service or product line.", "comment": "32 bit number; for values larger than this, use decimal", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.informationLinkId", "path": "Claim.item.informationLinkId", "short": "Applicable exception and supporting information", "definition": "Exceptions, special conditions and supporting information pplicable for this service or product line.", "comment": "32 bit number; for values larger than this, use decimal", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.revenue", "path": "Claim.item.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.category", "path": "Claim.item.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.service", "path": "Claim.item.service", "short": "Billing Code", "definition": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. 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 eg. 'glasses' or 'compound'.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-uscls" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.modifier", "path": "Claim.item.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for 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.", "comment": "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.", "requirements": "May impact on adjudication.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-modifiers" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.programCode", "path": "Claim.item.programCode", "short": "Program specific reason for item inclusion", "definition": "For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program.", "comment": "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.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProgramCode" } ], "strength": "example", "description": "Program specific reason codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-program-code" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.serviced[x]", "path": "Claim.item.serviced[x]", "short": "Date or dates of Service", "definition": "The date or dates when the enclosed suite of services were performed or completed.", "min": 0, "max": "1", "type": [ { "code": "date" }, { "code": "Period" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "when.done" } ] }, { "id": "Claim.item.location[x]", "path": "Claim.item.location[x]", "short": "Place of service", "definition": "Where the service was provided.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" }, { "code": "Address" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Location" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServicePlace" } ], "strength": "example", "description": "Place of service: pharmacy,school, prison, etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-place" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "where" } ] }, { "id": "Claim.item.quantity", "path": "Claim.item.quantity", "short": "Count of Products or Services", "definition": "The number of repetitions of a service or product.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Quantity", "profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "xpath": "not(exists(f:comparator))", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" } ] }, { "id": "Claim.item.unitPrice", "path": "Claim.item.unitPrice", "short": "Fee, charge or cost per point", "definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "MO" } ] }, { "id": "Claim.item.factor", "path": "Claim.item.factor", "short": "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.", "comment": "Do not use a IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "decimal" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.net", "path": "Claim.item.net", "short": "Total item cost", "definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.", "comment": "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.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "MO" } ] }, { "id": "Claim.item.udi", "path": "Claim.item.udi", "short": "Unique Device Identifier", "definition": "List of Unique Device Identifiers associated with this line item.", "comment": "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.", "requirements": "The UDI code and issuer if applicable for the supplied product.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Claim.item.bodySite", "path": "Claim.item.bodySite", "short": "Service Location", "definition": "Physical service site on the patient (limb, tooth, etc).", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "OralSites" } ], "strength": "example", "description": "The code for the teeth, quadrant, sextant and arch", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/tooth" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.subSite", "path": "Claim.item.subSite", "short": "Service Sub-location", "definition": "A region or surface of the site, eg. limb region or tooth surface(s).", "comment": "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.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Surface" } ], "strength": "example", "description": "The code for the tooth surface and surface combinations", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/surface" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.encounter", "path": "Claim.item.encounter", "short": "Encounters related to this billed item", "definition": "A billed item may include goods or services provided in multiple encounters.", "comment": "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.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Encounter" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Request.context" } ] }, { "id": "Claim.item.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Detail" } ], "path": "Claim.item.detail", "short": "Additional items", "definition": "Second tier of goods and services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.detail.id", "path": "Claim.item.detail.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.detail.extension", "path": "Claim.item.detail.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.item.detail.modifierExtension", "path": "Claim.item.detail.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.item.detail.sequence", "path": "Claim.item.detail.sequence", "short": "Service instance", "definition": "A service line number.", "comment": "32 bit number; for values larger than this, use decimal", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.detail.revenue", "path": "Claim.item.detail.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.category", "path": "Claim.item.detail.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.service", "path": "Claim.item.detail.service", "short": "Billing Code", "definition": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-uscls" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.modifier", "path": "Claim.item.detail.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for 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.", "comment": "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.", "requirements": "May impact on adjudication.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-modifiers" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.programCode", "path": "Claim.item.detail.programCode", "short": "Program specific reason for item inclusion", "definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.", "comment": "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.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProgramCode" } ], "strength": "example", "description": "Program specific reason codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-program-code" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.quantity", "path": "Claim.item.detail.quantity", "short": "Count of Products or Services", "definition": "The number of repetitions of a service or product.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Quantity", "profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "xpath": "not(exists(f:comparator))", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" } ] }, { "id": "Claim.item.detail.unitPrice", "path": "Claim.item.detail.unitPrice", "short": "Fee, charge or cost per point", "definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.", "comment": "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.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "MO" } ] }, { "id": "Claim.item.detail.factor", "path": "Claim.item.detail.factor", "short": "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.", "comment": "Do not use a IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "decimal" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.detail.net", "path": "Claim.item.detail.net", "short": "Total additional item cost", "definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.", "comment": "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.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "MO" } ] }, { "id": "Claim.item.detail.udi", "path": "Claim.item.detail.udi", "short": "Unique Device Identifier", "definition": "List of Unique Device Identifiers associated with this line item.", "comment": "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.", "requirements": "The UDI code and issuer if applicable for the supplied product.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Claim.item.detail.subDetail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "SubDetail" } ], "path": "Claim.item.detail.subDetail", "short": "Additional items", "definition": "Third tier of goods and services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.detail.subDetail.id", "path": "Claim.item.detail.subDetail.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.detail.subDetail.extension", "path": "Claim.item.detail.subDetail.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.item.detail.subDetail.modifierExtension", "path": "Claim.item.detail.subDetail.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.", "comment": "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Claim.item.detail.subDetail.sequence", "path": "Claim.item.detail.subDetail.sequence", "short": "Service instance", "definition": "A service line number.", "comment": "32 bit number; for values larger than this, use decimal", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.detail.subDetail.revenue", "path": "Claim.item.detail.subDetail.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.subDetail.category", "path": "Claim.item.detail.subDetail.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.subDetail.service", "path": "Claim.item.detail.subDetail.service", "short": "Billing Code", "definition": "A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-uscls" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.subDetail.modifier", "path": "Claim.item.detail.subDetail.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for 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.", "comment": "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.", "requirements": "May impact on adjudication.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-modifiers" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.subDetail.programCode", "path": "Claim.item.detail.subDetail.programCode", "short": "Program specific reason for item inclusion", "definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.", "comment": "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.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProgramCode" } ], "strength": "example", "description": "Program specific reason codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-program-code" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Claim.item.detail.subDetail.quantity", "path": "Claim.item.detail.subDetail.quantity", "short": "Count of Products or Services", "definition": "The number of repetitions of a service or product.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Quantity", "profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "xpath": "not(exists(f:comparator))", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" } ] }, { "id": "Claim.item.detail.subDetail.unitPrice", "path": "Claim.item.detail.subDetail.unitPrice", "short": "Fee, charge or cost per point", "definition": "The fee for an addittional service or product or charge.", "comment": "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.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "MO" } ] }, { "id": "Claim.item.detail.subDetail.factor", "path": "Claim.item.detail.subDetail.factor", "short": "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.", "comment": "Do not use a IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "decimal" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Claim.item.detail.subDetail.net", "path": "Claim.item.detail.subDetail.net", "short": "Net additional item cost", "definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.", "comment": "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.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "MO" } ] }, { "id": "Claim.item.detail.subDetail.udi", "path": "Claim.item.detail.subDetail.udi", "short": "Unique Device Identifier", "definition": "List of Unique Device Identifiers associated with this line item.", "comment": "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.", "requirements": "The UDI code and issuer if applicable for the supplied product.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "Claim.total", "path": "Claim.total", "short": "Total claim cost", "definition": "The total value of the claim.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "MO" } ] } ] }, "differential": { "element": [ { "id": "Claim", "path": "Claim", "short": "Claim, Pre-determination or Pre-authorization", "definition": "A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.", "min": 0, "max": "*", "mapping": [ { "identity": "workflow", "map": "Request" }, { "identity": "w5", "map": "financial.billing" } ] }, { "id": "Claim.identifier", "path": "Claim.identifier", "short": "Claim number", "definition": "The business identifier for the instance: claim number, pre-determination or pre-authorization number.", "min": 0, "max": "*", "type": [ { "code": "Identifier" } ], "mapping": [ { "identity": "workflow", "map": "Request.identifier" }, { "identity": "w5", "map": "id" } ] }, { "id": "Claim.status", "path": "Claim.status", "short": "active | cancelled | draft | entered-in-error", "definition": "The status of the resource instance.", "comment": "This element is labeled as a modifier because the status contains the code entered-in-error that marks the claim as not currently valid.", "min": 0, "max": "1", "type": [ { "code": "code" } ], "isModifier": true, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimStatus" } ], "strength": "required", "description": "A code specifying the state of the resource instance.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fm-status" } }, "mapping": [ { "identity": "workflow", "map": "Request.status" }, { "identity": "w5", "map": "status" } ] }, { "id": "Claim.type", "path": "Claim.type", "short": "Type or discipline", "definition": "The category of claim, eg, oral, pharmacy, vision, insitutional, professional.", "comment": "Affects which fields and value sets are used.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimType" } ], "strength": "required", "description": "The type or discipline-style of the claim", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-type" } }, "mapping": [ { "identity": "w5", "map": "class" } ] }, { "id": "Claim.subType", "path": "Claim.subType", "short": "Finer grained claim type information", "definition": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.", "comment": "This may contain the local bill type codes such as the US UB-04 bill type code.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimSubType" } ], "strength": "example", "description": "A more granular claim typecode", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-subtype" } }, "mapping": [ { "identity": "w5", "map": "class" } ] }, { "id": "Claim.use", "path": "Claim.use", "short": "complete | proposed | exploratory | other", "definition": "Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).", "min": 0, "max": "1", "type": [ { "code": "code" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Use" } ], "strength": "required", "description": "Complete, proposed, exploratory, other", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-use" } }, "mapping": [ { "identity": "w5", "map": "class" } ] }, { "id": "Claim.patient", "path": "Claim.patient", "short": "The subject of the Products and Services", "definition": "Patient Resource.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient" } ], "mapping": [ { "identity": "workflow", "map": "Request.subject" }, { "identity": "w5", "map": "who.focus" } ] }, { "id": "Claim.billablePeriod", "path": "Claim.billablePeriod", "short": "Period for charge submission", "definition": "The billable period for which charges are being submitted.", "min": 0, "max": "1", "type": [ { "code": "Period" } ], "mapping": [ { "identity": "w5", "map": "when.done" } ] }, { "id": "Claim.created", "path": "Claim.created", "short": "Creation date", "definition": "The date when the enclosed suite of services were performed or completed.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "mapping": [ { "identity": "workflow", "map": "Request.authoredOn" }, { "identity": "w5", "map": "when.recorded" } ] }, { "id": "Claim.enterer", "path": "Claim.enterer", "short": "Author", "definition": "Person who created the invoice/claim/pre-determination or pre-authorization.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "mapping": [ { "identity": "w5", "map": "who.author" } ] }, { "id": "Claim.insurer", "path": "Claim.insurer", "short": "Target", "definition": "The Insurer who is target of the request.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "mapping": [ { "identity": "workflow", "map": "Request.performer" } ] }, { "id": "Claim.provider", "path": "Claim.provider", "short": "Responsible provider", "definition": "The provider which is responsible for the bill, claim pre-determination, pre-authorization.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "mapping": [ { "identity": "workflow", "map": "Request.requester.agent" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "Claim.organization", "path": "Claim.organization", "short": "Responsible organization", "definition": "The organization which is responsible for the bill, claim pre-determination, pre-authorization.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "mapping": [ { "identity": "workflow", "map": "Request.requester.onBehalfOf" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "Claim.priority", "path": "Claim.priority", "short": "Desired processing priority", "definition": "Immediate (STAT), best effort (NORMAL), deferred (DEFER).", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProcessPriority" } ], "strength": "example", "description": "The timeliness with which processing is required: STAT, normal, Deferred", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/process-priority" } }, "mapping": [ { "identity": "workflow", "map": "Request.priority" } ] }, { "id": "Claim.fundsReserve", "path": "Claim.fundsReserve", "short": "Funds requested to be reserved", "definition": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "FundsReserve" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "For whom funds are to be reserved: (Patient, Provider, None).", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fundsreserve" } } }, { "id": "Claim.related", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "RelatedClaim" } ], "path": "Claim.related", "short": "Related Claims which may be revelant to processing this claimn", "definition": "Other claims which are related to this claim such as prior claim versions or for related services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "Claim.related.claim", "path": "Claim.related.claim", "short": "Reference to the related claim", "definition": "Other claims which are related to this claim such as prior claim versions or for related services.", "comment": "Do we need a relationship code?", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Claim" } ], "mapping": [ { "identity": "workflow", "map": "Request.replaces" } ] }, { "id": "Claim.related.relationship", "path": "Claim.related.relationship", "short": "How the reference claim is related", "definition": "For example prior or umbrella.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RelatedClaimRelationship" } ], "strength": "example", "description": "Relationship of this claim to a related Claim", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/related-claim-relationship" } } }, { "id": "Claim.related.reference", "path": "Claim.related.reference", "short": "Related file or case reference", "definition": "An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # .", "min": 0, "max": "1", "type": [ { "code": "Identifier" } ] }, { "id": "Claim.prescription", "path": "Claim.prescription", "short": "Prescription authorizing services or products", "definition": "Prescription to support the dispensing of Pharmacy or Vision products.", "comment": "Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence.", "requirements": "For type=Pharmacy and Vision only.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/MedicationRequest" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/VisionPrescription" } ] }, { "id": "Claim.originalPrescription", "path": "Claim.originalPrescription", "short": "Original prescription if superceded by fulfiller", "definition": "Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.", "comment": "as above.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/MedicationRequest" } ] }, { "id": "Claim.payee", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Payee" } ], "path": "Claim.payee", "short": "Party to be paid any benefits payable", "definition": "The party to be reimbursed for the services.", "min": 0, "max": "1", "type": [ { "code": "BackboneElement" } ] }, { "id": "Claim.payee.type", "path": "Claim.payee.type", "short": "Type of party: Subscriber, Provider, other", "definition": "Type of Party to be reimbursed: Subscriber, provider, other.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PayeeType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "A code for the party to be reimbursed.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/payeetype" } } }, { "id": "Claim.payee.resourceType", "path": "Claim.payee.resourceType", "short": "organization | patient | practitioner | relatedperson", "definition": "organization | patient | practitioner | relatedperson.", "min": 0, "max": "1", "type": [ { "code": "Coding" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimPayeeResourceType" } ], "strength": "example", "description": "The type of Claim payee Resource", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-payee-resource-type" } } }, { "id": "Claim.payee.party", "path": "Claim.payee.party", "short": "Party to receive the payable", "definition": "Party to be reimbursed: Subscriber, provider, other.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson" } ] }, { "id": "Claim.referral", "path": "Claim.referral", "short": "Treatment Referral", "definition": "The referral resource which lists the date, practitioner, reason and other supporting information.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/ReferralRequest" } ], "mapping": [ { "identity": "w5", "map": "who.cause" } ] }, { "id": "Claim.facility", "path": "Claim.facility", "short": "Servicing Facility", "definition": "Facility where the services were provided.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Location" } ], "mapping": [ { "identity": "w5", "map": "where" } ] }, { "id": "Claim.careTeam", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "CareTeam" } ], "path": "Claim.careTeam", "short": "Members of the care team", "definition": "The members of the team who provided the overall service as well as their role and whether responsible and qualifications.", "requirements": "Role and Responsible may not be required when there is only a single provider listed.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "Claim.careTeam.sequence", "path": "Claim.careTeam.sequence", "short": "Number to covey order of careTeam", "definition": "Sequence of the careTeam which serves to order and provide a link.", "requirements": "Required to maintain order of the careTeam.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.careTeam.provider", "path": "Claim.careTeam.provider", "short": "Provider individual or organization", "definition": "Member of the team who provided the overall service.", "min": 1, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "mapping": [ { "identity": "w5", "map": "who.actor" } ] }, { "id": "Claim.careTeam.responsible", "path": "Claim.careTeam.responsible", "short": "Billing provider", "definition": "The party who is billing and responsible for the claimed good or service rendered to the patient.", "min": 0, "max": "1", "type": [ { "code": "boolean" } ] }, { "id": "Claim.careTeam.role", "path": "Claim.careTeam.role", "short": "Role on the team", "definition": "The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CareTeamRole" } ], "strength": "example", "description": "The role codes for the care team members.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-careteamrole" } } }, { "id": "Claim.careTeam.qualification", "path": "Claim.careTeam.qualification", "short": "Type, classification or Specialization", "definition": "The qualification which is applicable for this service.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProviderQualification" } ], "strength": "example", "description": "Provider professional qualifications", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/provider-qualification" } } }, { "id": "Claim.information", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "SpecialCondition" } ], "path": "Claim.information", "short": "Exceptions, special considerations, the condition, situation, prior or concurrent issues", "definition": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.", "requirements": "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mapping": [ { "identity": "workflow", "map": "Request.supportingInfo" } ] }, { "id": "Claim.information.sequence", "path": "Claim.information.sequence", "short": "Information instance identifier", "definition": "Sequence of the information element which serves to provide a link.", "requirements": "To provide a reference link.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.information.category", "path": "Claim.information.category", "short": "General class of information", "definition": "The general class of the information supplied: information; exception; accident, employment; onset, etc.", "comment": "This may contain the local bill type codes such as the US UB-04 bill type code.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "InformationCategory" } ], "strength": "example", "description": "The valuset used for additional information category codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-informationcategory" } } }, { "id": "Claim.information.code", "path": "Claim.information.code", "short": "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 which may influence the adjudication.", "comment": "This may contain the local bill type codes such as the US UB-04 bill type code.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "InformationCode" } ], "strength": "example", "description": "The valuset used for additional information codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-exception" } } }, { "id": "Claim.information.timing[x]", "path": "Claim.information.timing[x]", "short": "When it occurred", "definition": "The date when or period to which this information refers.", "min": 0, "max": "1", "type": [ { "code": "date" }, { "code": "Period" } ] }, { "id": "Claim.information.value[x]", "path": "Claim.information.value[x]", "short": "Additional Data or supporting information", "definition": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.", "min": 0, "max": "1", "type": [ { "code": "string" }, { "code": "Quantity" }, { "code": "Attachment" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource" } ] }, { "id": "Claim.information.reason", "path": "Claim.information.reason", "short": "Reason associated with the information", "definition": "For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MissingReason" } ], "strength": "example", "description": "Reason codes for the missing teeth", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/missing-tooth-reason" } } }, { "id": "Claim.diagnosis", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Diagnosis" } ], "path": "Claim.diagnosis", "short": "List of Diagnosis", "definition": "List of patient diagnosis for which care is sought.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mapping": [ { "identity": "workflow", "map": "Request.reasonReference" } ] }, { "id": "Claim.diagnosis.sequence", "path": "Claim.diagnosis.sequence", "short": "Number to covey order of diagnosis", "definition": "Sequence of diagnosis which serves to provide a link.", "requirements": "Required to allow line items to reference the diagnoses.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.diagnosis.diagnosis[x]", "path": "Claim.diagnosis.diagnosis[x]", "short": "Patient's diagnosis", "definition": "The diagnosis.", "requirements": "Required to adjudicate services rendered to condition presented.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Condition" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ICD10" } ], "strength": "example", "description": "ICD10 Diagnostic codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/icd-10" } } }, { "id": "Claim.diagnosis.type", "path": "Claim.diagnosis.type", "short": "Timing or nature of the diagnosis", "definition": "The type of the Diagnosis, for example: admitting, primary, secondary, discharge.", "comment": "Diagnosis are presented in list order to their expected importance: primary, secondary, etc.", "requirements": "May be required to adjudicate services rendered.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DiagnosisType" } ], "strength": "example", "description": "The type of the diagnosis: admitting, principal, discharge", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-diagnosistype" } } }, { "id": "Claim.diagnosis.packageCode", "path": "Claim.diagnosis.packageCode", "short": "Package billing code", "definition": "The package billing code, for example DRG, based on the assigned grouping code system.", "requirements": "May be required to adjudicate services rendered to the mandated grouping system.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DiagnosisRelatedGroup" } ], "strength": "example", "description": "The DRG codes associated with the diagnosis", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup" } } }, { "id": "Claim.procedure", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Procedure" } ], "path": "Claim.procedure", "short": "Procedures performed", "definition": "Ordered list of patient procedures performed to support the adjudication.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "Claim.procedure.sequence", "path": "Claim.procedure.sequence", "short": "Procedure sequence for reference", "definition": "Sequence of procedures which serves to order and provide a link.", "requirements": "Required to maintain order of the procudures.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.procedure.date", "path": "Claim.procedure.date", "short": "When the procedure was performed", "definition": "Date and optionally time the procedure was performed .", "comment": "SB DateTime??", "requirements": "Required to adjudicate services rendered.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ] }, { "id": "Claim.procedure.procedure[x]", "path": "Claim.procedure.procedure[x]", "short": "Patient's list of procedures performed", "definition": "The procedure code.", "requirements": "Required to adjudicate services rendered.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Procedure" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ICD10_Procedures" } ], "strength": "example", "description": "ICD10 Procedure codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/icd-10-procedures" } } }, { "id": "Claim.insurance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Insurance" } ], "path": "Claim.insurance", "short": "Insurance or medical plan", "definition": "Financial instrument by which payment information for health care.", "requirements": "Health care programs and insurers are significant payors of health service costs.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mapping": [ { "identity": "rim", "map": "Coverage" } ] }, { "id": "Claim.insurance.sequence", "path": "Claim.insurance.sequence", "short": "Service instance identifier", "definition": "Sequence of coverage which serves to provide a link and convey coordination of benefit order.", "requirements": "To maintain order of the coverages.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.insurance.focal", "path": "Claim.insurance.focal", "short": "Is the focal Coverage", "definition": "A flag to indicate that this Coverage is the focus for adjudication. The Coverage against which the claim is to be adjudicated.", "requirements": "To identify which coverage is being adjudicated.", "min": 1, "max": "1", "type": [ { "code": "boolean" } ] }, { "id": "Claim.insurance.coverage", "path": "Claim.insurance.coverage", "short": "Insurance information", "definition": "Reference to the program or plan identification, underwriter or payor.", "requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.", "min": 1, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Coverage" } ] }, { "id": "Claim.insurance.businessArrangement", "path": "Claim.insurance.businessArrangement", "short": "Business agreement", "definition": "The contract number of a business agreement which describes the terms and conditions.", "min": 0, "max": "1", "type": [ { "code": "string" } ] }, { "id": "Claim.insurance.preAuthRef", "path": "Claim.insurance.preAuthRef", "short": "Pre-Authorization/Determination Reference", "definition": "A list of references from the Insurer to which these services pertain.", "requirements": "To provide any pre=determination or prior authorization reference.", "min": 0, "max": "*", "type": [ { "code": "string" } ] }, { "id": "Claim.insurance.claimResponse", "path": "Claim.insurance.claimResponse", "short": "Adjudication results", "definition": "The Coverages adjudication details.", "requirements": "Used by downstream payers to determine what balance remains and the net payable.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/ClaimResponse" } ] }, { "id": "Claim.accident", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Accident" } ], "path": "Claim.accident", "short": "Details about an accident", "definition": "An accident which resulted in the need for healthcare services.", "min": 0, "max": "1", "type": [ { "code": "BackboneElement" } ] }, { "id": "Claim.accident.date", "path": "Claim.accident.date", "short": "When the accident occurred\nsee information codes\nsee information codes", "definition": "Date of an accident which these services are addressing.", "requirements": "Coverage may be dependant on accidents.", "min": 1, "max": "1", "type": [ { "code": "date" } ] }, { "id": "Claim.accident.type", "path": "Claim.accident.type", "short": "The nature of the accident", "definition": "Type of accident: work, auto, etc.", "requirements": "Coverage may be dependant on the type of accident.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AccidentType" } ], "strength": "required", "description": "Type of accident: work place, auto, etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/v3-ActIncidentCode" } } }, { "id": "Claim.accident.location[x]", "path": "Claim.accident.location[x]", "short": "Accident Place", "definition": "Accident Place.", "min": 0, "max": "1", "type": [ { "code": "Address" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Location" } ] }, { "id": "Claim.employmentImpacted", "path": "Claim.employmentImpacted", "short": "Period unable to work", "definition": "The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).", "min": 0, "max": "1", "type": [ { "code": "Period" } ] }, { "id": "Claim.hospitalization", "path": "Claim.hospitalization", "short": "Period in hospital", "definition": "The start and optional end dates of when the patient was confined to a treatment center.", "min": 0, "max": "1", "type": [ { "code": "Period" } ] }, { "id": "Claim.item", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Item" } ], "path": "Claim.item", "short": "Goods and Services", "definition": "First tier of goods and services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "Claim.item.sequence", "path": "Claim.item.sequence", "short": "Service instance", "definition": "A service line number.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.item.careTeamLinkId", "path": "Claim.item.careTeamLinkId", "short": "Applicable careTeam members", "definition": "CareTeam applicable for this service or product line.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.item.diagnosisLinkId", "path": "Claim.item.diagnosisLinkId", "short": "Applicable diagnoses", "definition": "Diagnosis applicable for this service or product line.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.item.procedureLinkId", "path": "Claim.item.procedureLinkId", "short": "Applicable procedures", "definition": "Procedures applicable for this service or product line.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.item.informationLinkId", "path": "Claim.item.informationLinkId", "short": "Applicable exception and supporting information", "definition": "Exceptions, special conditions and supporting information pplicable for this service or product line.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.item.revenue", "path": "Claim.item.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } } }, { "id": "Claim.item.category", "path": "Claim.item.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } } }, { "id": "Claim.item.service", "path": "Claim.item.service", "short": "Billing Code", "definition": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. 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 eg. 'glasses' or 'compound'.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-uscls" } } }, { "id": "Claim.item.modifier", "path": "Claim.item.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for 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.", "requirements": "May impact on adjudication.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-modifiers" } } }, { "id": "Claim.item.programCode", "path": "Claim.item.programCode", "short": "Program specific reason for item inclusion", "definition": "For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProgramCode" } ], "strength": "example", "description": "Program specific reason codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-program-code" } } }, { "id": "Claim.item.serviced[x]", "path": "Claim.item.serviced[x]", "short": "Date or dates of Service", "definition": "The date or dates when the enclosed suite of services were performed or completed.", "min": 0, "max": "1", "type": [ { "code": "date" }, { "code": "Period" } ], "mapping": [ { "identity": "w5", "map": "when.done" } ] }, { "id": "Claim.item.location[x]", "path": "Claim.item.location[x]", "short": "Place of service", "definition": "Where the service was provided.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" }, { "code": "Address" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Location" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServicePlace" } ], "strength": "example", "description": "Place of service: pharmacy,school, prison, etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-place" } }, "mapping": [ { "identity": "w5", "map": "where" } ] }, { "id": "Claim.item.quantity", "path": "Claim.item.quantity", "short": "Count of Products or Services", "definition": "The number of repetitions of a service or product.", "min": 0, "max": "1", "type": [ { "code": "Quantity", "profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ] }, { "id": "Claim.item.unitPrice", "path": "Claim.item.unitPrice", "short": "Fee, charge or cost per point", "definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "Claim.item.factor", "path": "Claim.item.factor", "short": "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": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "decimal" } ] }, { "id": "Claim.item.net", "path": "Claim.item.net", "short": "Total item cost", "definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "Claim.item.udi", "path": "Claim.item.udi", "short": "Unique Device Identifier", "definition": "List of Unique Device Identifiers associated with this line item.", "requirements": "The UDI code and issuer if applicable for the supplied product.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device" } ] }, { "id": "Claim.item.bodySite", "path": "Claim.item.bodySite", "short": "Service Location", "definition": "Physical service site on the patient (limb, tooth, etc).", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "OralSites" } ], "strength": "example", "description": "The code for the teeth, quadrant, sextant and arch", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/tooth" } } }, { "id": "Claim.item.subSite", "path": "Claim.item.subSite", "short": "Service Sub-location", "definition": "A region or surface of the site, eg. limb region or tooth surface(s).", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Surface" } ], "strength": "example", "description": "The code for the tooth surface and surface combinations", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/surface" } } }, { "id": "Claim.item.encounter", "path": "Claim.item.encounter", "short": "Encounters related to this billed item", "definition": "A billed item may include goods or services provided in multiple encounters.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Encounter" } ], "mapping": [ { "identity": "workflow", "map": "Request.context" } ] }, { "id": "Claim.item.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Detail" } ], "path": "Claim.item.detail", "short": "Additional items", "definition": "Second tier of goods and services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "Claim.item.detail.sequence", "path": "Claim.item.detail.sequence", "short": "Service instance", "definition": "A service line number.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.item.detail.revenue", "path": "Claim.item.detail.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } } }, { "id": "Claim.item.detail.category", "path": "Claim.item.detail.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } } }, { "id": "Claim.item.detail.service", "path": "Claim.item.detail.service", "short": "Billing Code", "definition": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-uscls" } } }, { "id": "Claim.item.detail.modifier", "path": "Claim.item.detail.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for 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.", "requirements": "May impact on adjudication.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-modifiers" } } }, { "id": "Claim.item.detail.programCode", "path": "Claim.item.detail.programCode", "short": "Program specific reason for item inclusion", "definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProgramCode" } ], "strength": "example", "description": "Program specific reason codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-program-code" } } }, { "id": "Claim.item.detail.quantity", "path": "Claim.item.detail.quantity", "short": "Count of Products or Services", "definition": "The number of repetitions of a service or product.", "min": 0, "max": "1", "type": [ { "code": "Quantity", "profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ] }, { "id": "Claim.item.detail.unitPrice", "path": "Claim.item.detail.unitPrice", "short": "Fee, charge or cost per point", "definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "Claim.item.detail.factor", "path": "Claim.item.detail.factor", "short": "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": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "decimal" } ] }, { "id": "Claim.item.detail.net", "path": "Claim.item.detail.net", "short": "Total additional item cost", "definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "Claim.item.detail.udi", "path": "Claim.item.detail.udi", "short": "Unique Device Identifier", "definition": "List of Unique Device Identifiers associated with this line item.", "requirements": "The UDI code and issuer if applicable for the supplied product.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device" } ] }, { "id": "Claim.item.detail.subDetail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "SubDetail" } ], "path": "Claim.item.detail.subDetail", "short": "Additional items", "definition": "Third tier of goods and services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "Claim.item.detail.subDetail.sequence", "path": "Claim.item.detail.subDetail.sequence", "short": "Service instance", "definition": "A service line number.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "Claim.item.detail.subDetail.revenue", "path": "Claim.item.detail.subDetail.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } } }, { "id": "Claim.item.detail.subDetail.category", "path": "Claim.item.detail.subDetail.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } } }, { "id": "Claim.item.detail.subDetail.service", "path": "Claim.item.detail.subDetail.service", "short": "Billing Code", "definition": "A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-uscls" } } }, { "id": "Claim.item.detail.subDetail.modifier", "path": "Claim.item.detail.subDetail.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for 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.", "requirements": "May impact on adjudication.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-modifiers" } } }, { "id": "Claim.item.detail.subDetail.programCode", "path": "Claim.item.detail.subDetail.programCode", "short": "Program specific reason for item inclusion", "definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProgramCode" } ], "strength": "example", "description": "Program specific reason codes", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-program-code" } } }, { "id": "Claim.item.detail.subDetail.quantity", "path": "Claim.item.detail.subDetail.quantity", "short": "Count of Products or Services", "definition": "The number of repetitions of a service or product.", "min": 0, "max": "1", "type": [ { "code": "Quantity", "profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ] }, { "id": "Claim.item.detail.subDetail.unitPrice", "path": "Claim.item.detail.subDetail.unitPrice", "short": "Fee, charge or cost per point", "definition": "The fee for an addittional service or product or charge.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "Claim.item.detail.subDetail.factor", "path": "Claim.item.detail.subDetail.factor", "short": "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": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "decimal" } ] }, { "id": "Claim.item.detail.subDetail.net", "path": "Claim.item.detail.subDetail.net", "short": "Net additional item cost", "definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.", "requirements": "If a fee is present the associated product/service code must be present.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "Claim.item.detail.subDetail.udi", "path": "Claim.item.detail.subDetail.udi", "short": "Unique Device Identifier", "definition": "List of Unique Device Identifiers associated with this line item.", "requirements": "The UDI code and issuer if applicable for the supplied product.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device" } ] }, { "id": "Claim.total", "path": "Claim.total", "short": "Total claim cost", "definition": "The total value of the claim.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] } ] } }