{
  "resourceType": "StructureDefinition",
  "id": "bd288ae2-db3b-4380-985a-a40fb0e8525d",
  "url": "https://fhir.virtually.healthcare/StructureDefinition/Claim",
  "name": "VirtuallyHealthcareClaim",
  "status": "draft",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Claim",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Claim",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Claim",
        "path": "Claim",
        "definition": "This profile is designed to work with NHS BSA Claim API. \r\n\r\nIt is compatible via transformation, this will be part of the virtually API."
      },
      {
        "id": "Claim.identifier",
        "path": "Claim.identifier",
        "definition": "A unique identifier assigned to this claim.\r\n\r\nExample:\r\n\r\n```json\r\n\"identifier\": [\r\n      {\r\n          \"system\": \"https://fhir.nhsbsa.nhs.uk/Id/CpcsClientReference\",\r\n          \"value\": \"MYS-78917-13\"\r\n      }\r\n  ]\r\n```",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "Claim.identifier.system",
        "path": "Claim.identifier.system",
        "min": 1,
        "fixedUri": "https://fhir.nhsbsa.nhs.uk/Id/CpcsClientReference"
      },
      {
        "id": "Claim.identifier.value",
        "path": "Claim.identifier.value",
        "min": 1
      },
      {
        "id": "Claim.type",
        "path": "Claim.type",
        "definition": "This is a fixed value of \r\n\r\n```json\r\n  \"type\": {\r\n      \"coding\": [\r\n          {\r\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\r\n              \"code\": \"pharmacy\",\r\n              \"display\": \"Pharmacy\"\r\n          }\r\n      ]\r\n  },\r\n```",
        "mustSupport": true
      },
      {
        "id": "Claim.patient",
        "path": "Claim.patient",
        "definition": "The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.\r\n\r\nExample:\r\n\r\n```json\r\n \"patient\": {\r\n      \"reference\": \"Patient/6d4e737a-b119-4a26-84af-ef6b84c7a7dd\"\r\n  },\r\n```",
        "mustSupport": true
      },
      {
        "id": "Claim.billablePeriod",
        "path": "Claim.billablePeriod",
        "definition": "The period for which charges are being submitted.\r\n\r\nExample:\r\n\r\n```json\r\n \"billablePeriod\": {\r\n      \"start\": \"2021-07-01\"\r\n  },\r\n```",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Claim.billablePeriod.start",
        "path": "Claim.billablePeriod.start",
        "min": 1
      },
      {
        "id": "Claim.created",
        "path": "Claim.created",
        "comment": "This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.",
        "mustSupport": true
      },
      {
        "id": "Claim.provider",
        "path": "Claim.provider",
        "definition": "The provider which is responsible for the claim, predetermination or preauthorization.\r\n\r\nExample:\r\n\r\n```json\r\n \"provider\": {\r\n      \"reference\": \"Organization/88aaaa45-c1a0-4576-bc60-adc32e8d51d9\"\r\n  },\r\n```",
        "mustSupport": true
      },
      {
        "id": "Claim.provider.reference",
        "path": "Claim.provider.reference",
        "definition": "This should point to the Virtually FHIR Organization resource",
        "min": 1
      },
      {
        "id": "Claim.priority",
        "path": "Claim.priority",
        "definition": "This is a fixed value of \r\n\r\n```json\r\n \"priority\": {\r\n      \"coding\": [\r\n          {\r\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\r\n              \"code\": \"normal\"\r\n          }\r\n      ]\r\n  },\r\n```"
      },
      {
        "id": "Claim.referral",
        "path": "Claim.referral",
        "comment": "The referral resource which lists the date, practitioner, reason and other supporting information.\r\n\r\nExample:\r\n\r\n```json\r\n\"referral\": {\r\n      \"identifier\": {\r\n          \"system\": \"https://fhir.nhsbsa.nhs.uk/Id/UrgentCareReference\",\r\n          \"value\": \"w1UylmUJFiJVU4b7lwptT\"\r\n      }\r\n  }\r\n```",
        "mustSupport": true
      },
      {
        "id": "Claim.referral.identifier",
        "path": "Claim.referral.identifier",
        "min": 1
      },
      {
        "id": "Claim.supportingInfo",
        "path": "Claim.supportingInfo",
        "definition": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.\r\n\r\nExample: \r\n\r\n```json\r\n  \"supportingInfo\": [\r\n      {\r\n          \"sequence\": 1,\r\n          \"category\": {\r\n              \"coding\": [\r\n                  {\r\n                      \"system\": \"http://terminology.hl7.org/CodeSystem/claiminformationcategory\",\r\n                      \"code\": \"attachment\"\r\n                  }\r\n              ]\r\n          },\r\n          \"valueReference\": {\r\n              \"reference\": \"QuestionnaireResponse/876eed48-b411-4954-a682-03b9571c2c88\"\r\n          }\r\n      }\r\n  ]\r\n```",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Claim.supportingInfo.category",
        "path": "Claim.supportingInfo.category",
        "definition": "Fixed value of\r\n\r\n```json\r\n   \"category\": {\r\n              \"coding\": [\r\n                  {\r\n                      \"system\": \"http://terminology.hl7.org/CodeSystem/claiminformationcategory\",\r\n                      \"code\": \"attachment\"\r\n                  }\r\n              ]\r\n          },\r\n```"
      },
      {
        "id": "Claim.supportingInfo.value[x]",
        "path": "Claim.supportingInfo.value[x]",
        "definition": "This MUST reference a Virtually FHIR QuestionnaireResponse which contains the supporting claim information. \r\n\r\nThe definition of this QuestionnaireResponse is held in [Virtually BSA Questionnaire](https://simplifier.net/guide/Virtually-Healthcare-FHIR-API/Home/Questionnaire/NHSBSA-Claim-SuppportingInfo.page.md?version=current)",
        "min": 1,
        "type": [
          {
            "code": "Reference"
          }
        ]
      },
      {
        "id": "Claim.insurance",
        "path": "Claim.insurance",
        "definition": "This is a fixed value of \r\n\r\n```json\r\n\"insurance\": [\r\n      {\r\n          \"sequence\": 1,\r\n          \"focal\": true,\r\n          \"coverage\": {\r\n              \"identifier\": {\r\n                  \"system\": \"https://fhir.nhs.uk/Id/ods-organization-code\",\r\n                  \"value\": \"T1450\"\r\n              },\r\n              \"display\": \"NHS BUSINESS SERVICES AUTHORITY\"\r\n          }\r\n      }\r\n  ],\r\n```",
        "mustSupport": true
      },
      {
        "id": "Claim.item",
        "path": "Claim.item",
        "definition": "A claim line. Either a simple  product or service or a 'group' of details which can each be a simple items or groups of sub-details.\r\n\r\nExample:\r\n\r\n```json\r\n\"item\": [\r\n      {\r\n          \"sequence\": 1,\r\n          \"productOrService\": {\r\n              \"coding\": [\r\n                  {\r\n                      \"system\": \"https://fhir.nhsbsa.nhs.uk/Id/CpcsType\",\r\n                      \"code\": \"EMG_MED\",\r\n                      \"display\": \"NHS Urgent Medicines Supply\"\r\n                  }\r\n              ]\r\n          },\r\n          \"programCode\": [\r\n              {\r\n                  \"coding\": [\r\n                      {\r\n                          \"system\": \"https://fhir.nhsbsa.nhs.uk/Id/ExemptionType\",\r\n                          \"code\": \"A\",\r\n                          \"display\": \"60 years of age or over or is under 16 years of age\"\r\n                      }\r\n                  ]\r\n              }\r\n          ]\r\n      }\r\n  ]\r\n```",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Claim.item.productOrService",
        "path": "Claim.item.productOrService",
        "definition": "Fixed value of \r\n\r\n```json\r\n\r\n```",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://fhir.nhsbsa.nhs.uk/ValueSet/CpcsType"
        }
      },
      {
        "id": "Claim.item.productOrService.coding",
        "path": "Claim.item.productOrService.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Claim.item.productOrService.coding.system",
        "path": "Claim.item.productOrService.coding.system",
        "min": 1
      },
      {
        "id": "Claim.item.productOrService.coding.code",
        "path": "Claim.item.productOrService.coding.code",
        "min": 1
      },
      {
        "id": "Claim.item.productOrService.coding.display",
        "path": "Claim.item.productOrService.coding.display",
        "min": 1
      },
      {
        "id": "Claim.item.programCode",
        "path": "Claim.item.programCode",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://fhir.nhsbsa.nhs.uk/ValueSet/ExemptionType"
        }
      },
      {
        "id": "Claim.item.programCode.coding",
        "path": "Claim.item.programCode.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Claim.item.programCode.coding.system",
        "path": "Claim.item.programCode.coding.system",
        "min": 1
      },
      {
        "id": "Claim.item.programCode.coding.code",
        "path": "Claim.item.programCode.coding.code",
        "min": 1
      },
      {
        "id": "Claim.item.programCode.coding.display",
        "path": "Claim.item.programCode.coding.display",
        "min": 1
      }
    ]
  }
}