Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
DomainResource | Claim, Pre-determination or Pre-authorization Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |||
0..* | Identifier | Claim number | ||
?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Financial Resource Status Codes (Required) | |
0..1 | CodeableConcept | Type or discipline Example Claim Type Codes (Required) | ||
0..* | CodeableConcept | Finer grained claim type information Example Claim SubType Codes (Example) | ||
0..1 | code | complete | proposed | exploratory | other Use (Required) | ||
0..1 | Reference(Patient) | The subject of the Products and Services | ||
0..1 | Period | Period for charge submission | ||
0..1 | dateTime | Creation date | ||
0..1 | Reference(Practitioner) | Author | ||
0..1 | Reference(Organization) | Target | ||
0..1 | Reference(Practitioner) | Responsible provider | ||
0..1 | Reference(Organization) | Responsible organization | ||
0..1 | CodeableConcept | Desired processing priority Process Priority Codes (Example) | ||
0..1 | CodeableConcept | Funds requested to be reserved Funds Reservation Codes (Example) | ||
0..* | BackboneElement | Related Claims which may be revelant to processing this claimn | ||
0..1 | Reference(Claim) | Reference to the related claim | ||
0..1 | CodeableConcept | How the reference claim is related Example Related Claim Relationship Codes (Example) | ||
0..1 | Identifier | Related file or case reference | ||
0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | ||
0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | ||
0..1 | BackboneElement | Party to be paid any benefits payable | ||
1..1 | CodeableConcept | Type of party: Subscriber, Provider, other Claim Payee Type Codes (Example) | ||
0..1 | Coding | organization | patient | practitioner | relatedperson ClaimPayeeResourceType (Example) | ||
0..1 | Reference(Practitioner | Organization | Patient | RelatedPerson) | Party to receive the payable | ||
0..1 | Reference(ReferralRequest) | Treatment Referral | ||
0..1 | Reference(Location) | Servicing Facility | ||
0..* | BackboneElement | Members of the care team | ||
1..1 | positiveInt | Number to covey order of careTeam | ||
1..1 | Reference(Practitioner | Organization) | Provider individual or organization | ||
0..1 | boolean | Billing provider | ||
0..1 | CodeableConcept | Role on the team Claim Care Team Role Codes (Example) | ||
0..1 | CodeableConcept | Type, classification or Specialization Example Provider Qualification Codes (Example) | ||
0..* | BackboneElement | Exceptions, special considerations, the condition, situation, prior or concurrent issues | ||
1..1 | positiveInt | Information instance identifier | ||
1..1 | CodeableConcept | General class of information Claim Information Category Codes (Example) | ||
0..1 | CodeableConcept | Type of information Exception Codes (Example) | ||
0..1 | When it occurred | |||
date | ||||
Period | ||||
0..1 | Additional Data or supporting information | |||
string | ||||
Quantity | ||||
Attachment | ||||
Reference(Any) | ||||
0..1 | CodeableConcept | Reason associated with the information Missing Tooth Reason Codes (Example) | ||
0..* | BackboneElement | List of Diagnosis | ||
1..1 | positiveInt | Number to covey order of diagnosis | ||
1..1 | Patient's diagnosis ICD-10 Codes (Example) | |||
CodeableConcept | ||||
Reference(Condition) | ||||
0..* | CodeableConcept | Timing or nature of the diagnosis Example Diagnosis Type Codes (Example) | ||
0..1 | CodeableConcept | Package billing code Example Diagnosis Related Group Codes (Example) | ||
0..* | BackboneElement | Procedures performed | ||
1..1 | positiveInt | Procedure sequence for reference | ||
0..1 | dateTime | When the procedure was performed | ||
1..1 | Patient's list of procedures performed ICD-10 Procedure Codes (Example) | |||
CodeableConcept | ||||
Reference(Procedure) | ||||
0..* | BackboneElement | Insurance or medical plan | ||
1..1 | positiveInt | Service instance identifier | ||
1..1 | boolean | Is the focal Coverage | ||
1..1 | Reference(Coverage) | Insurance information | ||
0..1 | string | Business agreement | ||
0..* | string | Pre-Authorization/Determination Reference | ||
0..1 | Reference(ClaimResponse) | Adjudication results | ||
0..1 | BackboneElement | Details about an accident | ||
1..1 | date | When the accident occurred see information codes see information codes | ||
0..1 | CodeableConcept | The nature of the accident ActIncidentCode (Required) | ||
0..1 | Accident Place | |||
Address | ||||
Reference(Location) | ||||
0..1 | Period | Period unable to work | ||
0..1 | Period | Period in hospital | ||
0..* | BackboneElement | Goods and Services | ||
1..1 | positiveInt | Service instance | ||
0..* | positiveInt | Applicable careTeam members | ||
0..* | positiveInt | Applicable diagnoses | ||
0..* | positiveInt | Applicable procedures | ||
0..* | positiveInt | Applicable exception and supporting information | ||
0..1 | CodeableConcept | Revenue or cost center code Example Revenue Center Codes (Example) | ||
0..1 | CodeableConcept | Type of service or product Benefit SubCategory Codes (Example) | ||
0..1 | CodeableConcept | Billing Code USCLS Codes (Example) | ||
0..* | CodeableConcept | Service/Product billing modifiers Modifier type Codes (Example) | ||
0..* | CodeableConcept | Program specific reason for item inclusion Example Program Reason Codes (Example) | ||
0..1 | Date or dates of Service | |||
date | ||||
Period | ||||
0..1 | Place of service Example Service Place Codes (Example) | |||
CodeableConcept | ||||
Address | ||||
Reference(Location) | ||||
0..1 | SimpleQuantity | Count of Products or Services | ||
0..1 | Money | Fee, charge or cost per point | ||
0..1 | decimal | Price scaling factor | ||
0..1 | Money | Total item cost | ||
0..* | Reference(Device) | Unique Device Identifier | ||
0..1 | CodeableConcept | Service Location Oral Site Codes (Example) | ||
0..* | CodeableConcept | Service Sub-location Surface Codes (Example) | ||
0..* | Reference(Encounter) | Encounters related to this billed item | ||
0..* | BackboneElement | Additional items | ||
1..1 | positiveInt | Service instance | ||
0..1 | CodeableConcept | Revenue or cost center code Example Revenue Center Codes (Example) | ||
0..1 | CodeableConcept | Type of service or product Benefit SubCategory Codes (Example) | ||
0..1 | CodeableConcept | Billing Code USCLS Codes (Example) | ||
0..* | CodeableConcept | Service/Product billing modifiers Modifier type Codes (Example) | ||
0..* | CodeableConcept | Program specific reason for item inclusion Example Program Reason Codes (Example) | ||
0..1 | SimpleQuantity | Count of Products or Services | ||
0..1 | Money | Fee, charge or cost per point | ||
0..1 | decimal | Price scaling factor | ||
0..1 | Money | Total additional item cost | ||
0..* | Reference(Device) | Unique Device Identifier | ||
0..* | BackboneElement | Additional items | ||
1..1 | positiveInt | Service instance | ||
0..1 | CodeableConcept | Revenue or cost center code Example Revenue Center Codes (Example) | ||
0..1 | CodeableConcept | Type of service or product Benefit SubCategory Codes (Example) | ||
0..1 | CodeableConcept | Billing Code USCLS Codes (Example) | ||
0..* | CodeableConcept | Service/Product billing modifiers Modifier type Codes (Example) | ||
0..* | CodeableConcept | Program specific reason for item inclusion Example Program Reason Codes (Example) | ||
0..1 | SimpleQuantity | Count of Products or Services | ||
0..1 | Money | Fee, charge or cost per point | ||
0..1 | decimal | Price scaling factor | ||
0..1 | Money | Net additional item cost | ||
0..* | Reference(Device) | Unique Device Identifier | ||
0..1 | Money | Total claim cost | ||
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