| Package | NTT.HealthgenIG |
| Type | StructureDefinition |
| Id | Id |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=NTT.HealthgenIG@0.0.4&canonical=https://dxp.com/fhir/StructureDefinition/DXPClaim |
| Url | https://dxp.com/fhir/StructureDefinition/DXPClaim |
| Status | draft |
| Date | 2022-09-28T10:19:00.3077067+00:00 |
| Name | DXPClaim |
| Experimental | False |
| Type | Claim |
| Kind | resource |
No resources found
No resources found
FHIR{
"resourceType" : "StructureDefinition",
"url" : "https://dxp.com/fhir/StructureDefinition/DXPClaim",
"name" : "DXPClaim",
"status" : "draft",
"date" : "2022-09-28T10:19:00.3077067+00:00",
"fhirVersion" : "4.0.1",
"kind" : "resource",
"abstract" : false,
"type" : "Claim",
"baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Claim",
"derivation" : "constraint",
"snapshot" : {
"element" : [
{
"id" : "Claim",
"path" : "Claim",
"short" : "Claim, Pre-determination or Pre-authorization",
"definition" : "A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.",
"comment" : "The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.",
"alias" : [
"Adjudication Request",
"Preauthorization Request",
"Predetermination Request"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim",
"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-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 or SHALL refer to the containing resource",
"expression" : "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()",
"xpath" : "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean" : true
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown" : "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
"key" : "dom-6",
"severity" : "warning",
"human" : "A resource should have narrative for robust management",
"expression" : "text.`div`.exists()",
"xpath" : "exists(f:text/h:div)",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-5",
"severity" : "error",
"human" : "If a resource is contained in another resource, it SHALL NOT have a security label",
"expression" : "contained.meta.security.empty()",
"xpath" : "not(exists(f:contained/*/f:meta/f:security))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "Entity. Role, or Act"
},
{
"identity" : "workflow",
"map" : "Request"
}
]
},
{
"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" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isSummary" : true
},
{
"id" : "Claim.meta",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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 might 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "Claim.meta.id",
"path" : "Claim.meta.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.meta.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.meta.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. 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 can 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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.meta.versionId",
"path" : "Claim.meta.versionId",
"short" : "Version specific identifier",
"definition" : "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.",
"comment" : "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Meta.versionId",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.meta.lastUpdated",
"path" : "Claim.meta.lastUpdated",
"short" : "When the resource version last changed",
"definition" : "When the resource last changed - e.g. when the version changed.",
"comment" : "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http.html#read) interaction.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Meta.lastUpdated",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "instant"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.meta.source",
"path" : "Claim.meta.source",
"short" : "Identifies where the resource comes from",
"definition" : "A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.",
"comment" : "In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Meta.source",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.meta.profile",
"path" : "Claim.meta.profile",
"short" : "Profiles this resource claims to conform to",
"definition" : "A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).",
"comment" : "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Meta.profile",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "canonical",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/StructureDefinition"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.meta.security",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.meta.security",
"short" : "Security Labels applied to this resource",
"definition" : "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.",
"comment" : "The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Meta.security",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Coding"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "SecurityLabels"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}
],
"strength" : "extensible",
"description" : "Security Labels from the Healthcare Privacy and Security Classification System.",
"valueSet" : "http://hl7.org/fhir/ValueSet/security-labels"
},
"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.meta.tag",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.meta.tag",
"short" : "Tags applied to this resource",
"definition" : "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.",
"comment" : "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Meta.tag",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Coding"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Tags"
}
],
"strength" : "example",
"description" : "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".",
"valueSet" : "http://hl7.org/fhir/ValueSet/common-tags"
},
"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.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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : true,
"isModifierReason" : "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Language"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}
],
"strength" : "preferred",
"description" : "A human language.",
"valueSet" : "http://hl7.org/fhir/ValueSet/languages"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.text",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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 can 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 information 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"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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. 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 can 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "Claim.identifier",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.identifier",
"short" : "Business Identifier for claim",
"definition" : "A unique identifier assigned to this claim.",
"requirements" : "Allows claims to be distinguished and referenced.",
"alias" : [
"Claim Number"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.identifier",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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 - 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" : "FiveWs.identifier"
}
]
},
{
"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 codes that mark the resource as not currently valid.",
"requirements" : "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.status",
"min" : 1,
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : true,
"isModifierReason" : "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"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.",
"valueSet" : "http://hl7.org/fhir/ValueSet/fm-status|4.0.1"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "workflow",
"map" : "Request.status"
},
{
"identity" : "w5",
"map" : "FiveWs.status"
}
]
},
{
"id" : "Claim.type",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.type",
"short" : "Category or discipline",
"definition" : "The category of claim, e.g. oral, pharmacy, vision, institutional, professional.",
"comment" : "The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.",
"requirements" : "Claim type determine the general sets of business rules applied for information requirements and adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.type",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimType"
}
],
"strength" : "extensible",
"description" : "The type or discipline-style of the claim.",
"valueSet" : "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" : "FiveWs.class"
}
]
},
{
"id" : "Claim.subType",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.subType",
"short" : "More granular claim type",
"definition" : "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.",
"comment" : "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.",
"requirements" : "Some jurisdictions need a finer grained claim type for routing and adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.subType",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimSubType"
}
],
"strength" : "example",
"description" : "A more granular claim typecode.",
"valueSet" : "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" : "FiveWs.class"
}
]
},
{
"id" : "Claim.use",
"path" : "Claim.use",
"short" : "claim | preauthorization | predetermination",
"definition" : "A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.",
"comment" : "Note that FHIR strings SHALL NOT exceed 1MB in size",
"requirements" : "This element is required to understand the nature of the request for adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.use",
"min" : 1,
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Use"
}
],
"strength" : "required",
"description" : "The purpose of the Claim: predetermination, preauthorization, claim.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-use|4.0.1"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "Claim.patient",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.patient",
"short" : "The recipient of the products and services",
"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.",
"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 patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.patient",
"min" : 1,
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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"
}
],
"isSummary" : true,
"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" : "FiveWs.subject[x]"
},
{
"identity" : "w5",
"map" : "FiveWs.subject"
}
]
},
{
"id" : "Claim.billablePeriod",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.billablePeriod",
"short" : "Relevant time frame for the claim",
"definition" : "The period for which charges are being submitted.",
"comment" : "Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.",
"requirements" : "A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.billablePeriod",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "per-1",
"severity" : "error",
"human" : "If present, start SHALL have a lower value than end",
"expression" : "start.hasValue().not() or end.hasValue().not() or (start <= end)",
"xpath" : "not(exists(f:start/@value)) or not(exists(f:end/@value)) or (xs:dateTime(f:start/@value) <= xs:dateTime(f:end/@value))",
"source" : "http://hl7.org/fhir/StructureDefinition/Period"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "DR"
},
{
"identity" : "rim",
"map" : "IVL<TS>[lowClosed=\"true\" and highClosed=\"true\"] or URG<TS>[lowClosed=\"true\" and highClosed=\"true\"]"
},
{
"identity" : "w5",
"map" : "FiveWs.done[x]"
}
]
},
{
"id" : "Claim.created",
"path" : "Claim.created",
"short" : "Resource creation date",
"definition" : "The date this resource was 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.",
"requirements" : "Need to record a timestamp for use by both the recipient and the issuer.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.created",
"min" : 1,
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "workflow",
"map" : "Request.authoredOn"
},
{
"identity" : "w5",
"map" : "FiveWs.recorded"
}
]
},
{
"id" : "Claim.enterer",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.enterer",
"short" : "Author of the claim",
"definition" : "Individual who created the claim, predetermination or preauthorization.",
"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" : "Some jurisdictions require the contact information for personnel completing claims.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.enterer",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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" : "FiveWs.author"
}
]
},
{
"id" : "Claim.insurer",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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",
"base" : {
"path" : "Claim.insurer",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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"
}
],
"isSummary" : true,
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.provider",
"short" : "Party responsible for the claim",
"definition" : "The provider which is responsible for the claim, predetermination or preauthorization.",
"comment" : "Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.provider",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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"
}
],
"isSummary" : true,
"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"
},
{
"identity" : "w5",
"map" : "FiveWs.source"
}
]
},
{
"id" : "Claim.priority",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.priority",
"short" : "Desired processing ugency",
"definition" : "The provider-required urgency of processing the request. Typical values include: stat, routine deferred.",
"comment" : "If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.",
"requirements" : "The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.priority",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"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.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.fundsReserve",
"short" : "For whom to reserve funds",
"definition" : "A code to indicate whether and for whom funds are to be reserved for future claims.",
"comment" : "This field is only used for preauthorizations.",
"requirements" : "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.",
"alias" : [
"Fund pre-allocation"
],
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.fundsReserve",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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).",
"valueSet" : "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-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "RelatedClaim"
}
],
"path" : "Claim.related",
"short" : "Prior or corollary claims",
"definition" : "Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.",
"comment" : "For example, for the original treatment and follow-up exams.",
"requirements" : "For workplace or other accidents it is common to relate separate claims arising from the same event.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.related",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.related.id",
"path" : "Claim.related.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.related.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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. 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 can 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.related.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "Claim.related.claim",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.related.claim",
"short" : "Reference to the related claim",
"definition" : "Reference to a related claim.",
"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" : "For workplace or other accidents it is common to relate separate claims arising from the same event.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.related.claim",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.related.relationship",
"short" : "How the reference claim is related",
"definition" : "A code to convey how the claims are related.",
"comment" : "For example, prior claim or umbrella.",
"requirements" : "Some insurers need a declaration of the type of relationship.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.related.relationship",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RelatedClaimRelationship"
}
],
"strength" : "example",
"description" : "Relationship of this claim to a related Claim.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.related.reference",
"short" : "File or case reference",
"definition" : "An alternate organizational reference to the case or file to which this particular claim pertains.",
"comment" : "For example, Property/Casualty insurer claim # or Workers Compensation case # .",
"requirements" : "In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.related.reference",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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 - 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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.prescription",
"short" : "Prescription authorizing services and products",
"definition" : "Prescription to support the dispensing of pharmacy, device or vision products.",
"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" : "Required to authorize the dispensing of controlled substances and devices.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.prescription",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/DeviceRequest",
"http://hl7.org/fhir/StructureDefinition/MedicationRequest",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.originalPrescription",
"short" : "Original prescription if superseded by fulfiller",
"definition" : "Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.",
"comment" : "For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.",
"requirements" : "Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.originalPrescription",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/DeviceRequest",
"http://hl7.org/fhir/StructureDefinition/MedicationRequest",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
& {
"id" : "Claim.careTeam.sequence",
"path" : "Claim.careTeam.sequence",
"short" : "Order of care team",
"definition" : "A number to uniquely identify care team entries.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.careTeam.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "DiagnosisOnAdmission"
}
],
"strength" : "example",
"description" : "Present on admission.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission"
},
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.diagnosis.packageCode",
"short" : "Package billing code",
"definition" : "A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.",
"comment" : "For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.",
"requirements" : "Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.diagnosis.packageCode",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "DiagnosisRelatedGroup"
}
],
"strength" : "example",
"description" : "The DRG codes associated with the diagnosis.",
"valueSet" : "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-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Procedure"
}
],
"path" : "Claim.procedure",
"short" : "Clinical procedures performed",
"definition" : "Procedures performed on the patient relevant to the billing items with the claim.",
"requirements" : "The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.procedure",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.procedure.id",
"path" : "Claim.procedure.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.procedure.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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. 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 can 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.procedure.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "Claim.procedure.sequence",
"path" : "Claim.procedure.sequence",
"short" : "Procedure instance identifier",
"definition" : "A number to uniquely identify procedure entries.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Necessary to provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.procedure.sequence",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.procedure.type",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.procedure.type",
"short" : "Category of Procedure",
"definition" : "When the condition was observed or the relative ranking.",
"comment" : "For example: primary, secondary.",
"requirements" : "Often required to capture a particular diagnosis, for example: primary or discharge.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.procedure.type",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProcedureType"
}
],
"strength" : "example",
"description" : "Example procedure type codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-procedure-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"
}
]
},
{
"id" : "Claim.procedure.date",
"path" : "Claim.procedure.date",
"short" : "When the procedure was performed",
"definition" : "Date and optionally time the procedure was performed.",
"requirements" : "Required for auditing purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.procedure.date",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.procedure.procedure[x]",
"path" : "Claim.procedure.procedure[x]",
"short" : "Specific clinical procedure",
"definition" : "The code or reference to a Procedure resource which identifies the clinical intervention performed.",
"requirements" : "This identifies the actual clinical procedure.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.procedure.procedure[x]",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ICD10_Procedures"
}
],
"strength" : "example",
"description" : "Example ICD10 Procedure codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/icd-10-procedures"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.procedure.udi",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.procedure.udi",
"short" : "Unique device identifier",
"definition" : "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 allows the insurer to obtain device level information on the product supplied.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.procedure.udi",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Insurance"
}
],
"path" : "Claim.insurance",
"short" : "Patient insurance information",
"definition" : "Financial instruments for reimbursement for the health care products and services specified on the claim.",
"comment" : "All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.",
"requirements" : "At least one insurer is required for a claim to be a claim.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "Claim.insurance",
"min" : 1,
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "Coverage"
}
]
},
{
"id" : "Claim.insurance.id",
"path" : "Claim.insurance.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.insurance.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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. 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 can 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.insurance.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "Claim.insurance.sequence",
"path" : "Claim.insurance.sequence",
"short" : "Insurance instance identifier",
"definition" : "A number to uniquely identify insurance entries and provide a sequence of coverages to 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",
"base" : {
"path" : "Claim.insurance.sequence",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.insurance.focal",
"path" : "Claim.insurance.focal",
"short" : "Coverage to be used for adjudication",
"definition" : "A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.",
"comment" : "A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.",
"requirements" : "To identify which coverage in the list is being used to adjudicate this claim.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.insurance.focal",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.insurance.identifier",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.insurance.identifier",
"short" : "Pre-assigned Claim number",
"definition" : "The business identifier to be used when the claim is sent for adjudication against this insurance policy.",
"comment" : "Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'.",
"requirements" : "This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.insurance.identifier",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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 - 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" : "FiveWs.identifier"
}
]
},
{
"id" : "Claim.insurance.coverage",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.insurance.coverage",
"short" : "Insurance information",
"definition" : "Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.",
"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" : "Required to allow the adjudicator to locate the correct policy and history within their information system.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.insurance.coverage",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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"
}
],
"isSummary" : true,
"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" : "Additional provider contract number",
"definition" : "A business agreement number established between the provider and the insurer for special business processing purposes.",
"comment" : "Note that FHIR strings SHALL NOT exceed 1MB in size",
"requirements" : "Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.insurance.businessArrangement",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.insurance.preAuthRef",
"path" : "Claim.insurance.preAuthRef",
"short" : "Prior authorization reference number",
"definition" : "Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.",
"comment" : "This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.",
"requirements" : "Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.insurance.preAuthRef",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.insurance.claimResponse",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.insurance.claimResponse",
"short" : "Adjudication results",
"definition" : "The result of the adjudication of the line items for the Coverage specified in this insurance.",
"comment" : "Must not be specified when 'focal=true' for this insurance.",
"requirements" : "An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.insurance.claimResponse",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Accident"
}
],
"path" : "Claim.accident",
"short" : "Details of the event",
"definition" : "Details of an accident which resulted in injuries which required the products and services listed in the claim.",
"requirements" : "When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.accident",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.accident.id",
"path" : "Claim.accident.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.accident.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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. 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 can 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.accident.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "Claim.accident.date",
"path" : "Claim.accident.date",
"short" : "When the incident occurred",
"definition" : "Date of an accident event related to the products and services contained in the claim.",
"comment" : "The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.",
"requirements" : "Required for audit purposes and adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.accident.date",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.accident.type",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.accident.type",
"short" : "The nature of the accident",
"definition" : "The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.",
"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",
"base" : {
"path" : "Claim.accident.type",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AccidentType"
}
],
"strength" : "extensible",
"description" : "Type of accident: work place, auto, etc.",
"valueSet" : "http://terminology.hl7.org/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" : "Where the event occurred",
"definition" : "The physical location of the accident event.",
"requirements" : "Required for audit purposes and determination of applicable insurance liability.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.accident.location[x]",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Item"
}
],
"path" : "Claim.item",
"short" : "Product or service provided",
"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.",
"requirements" : "The items to be processed for adjudication.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.id",
"path" : "Claim.item.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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. 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 can 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "Claim.item.sequence",
"path" : "Claim.item.sequence",
"short" : "Item instance identifier",
"definition" : "A number to uniquely identify item entries.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.item.sequence",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.careTeamSequence",
"path" : "Claim.item.careTeamSequence",
"short" : "Applicable careTeam members",
"definition" : "CareTeam members related to this service or product.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Need to identify the individuals and their roles in the provision of the product or service.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.careTeamSequence",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.diagnosisSequence",
"path" : "Claim.item.diagnosisSequence",
"short" : "Applicable diagnoses",
"definition" : "Diagnosis applicable for this service or product.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Need to related the product or service to the associated diagnoses.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.diagnosisSequence",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.procedureSequence",
"path" : "Claim.item.procedureSequence",
"short" : "Applicable procedures",
"definition" : "Procedures applicable for this service or product.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Need to provide any listed specific procedures to support the product or service being claimed.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.procedureSequence",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.informationSequence",
"path" : "Claim.item.informationSequence",
"short" : "Applicable exception and supporting information",
"definition" : "Exceptions, special conditions and supporting information applicable for this service or product.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Need to reference the supporting information items that relate directly to this product or service.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.informationSequence",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.revenue",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.revenue",
"short" : "Revenue or cost center code",
"definition" : "The type of revenue 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.",
"requirements" : "Needed in the processing of institutional claims.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.revenue",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.category",
"short" : "Benefit classification",
"definition" : "Code to identify the general type of benefits under which products and services are provided.",
"comment" : "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
"requirements" : "Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.category",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitCategory"
}
],
"strength" : "example",
"description" : "Benefit categories such as: oral-basic, major, glasses.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-benefitcategory"
},
"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.productOrService",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"alias" : [
"Drug Code",
"Bill Code",
"Service Code"
],
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.item.productOrService",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.modifier",
"short" : "Product or service billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.modifier",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.programCode",
"short" : "Program the product or service is provided under",
"definition" : "Identifies the program under which this may be recovered.",
"comment" : "For example: Neonatal program, child dental program or drug users recovery program.",
"requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.programCode",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}
],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "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 or product delivery",
"definition" : "The date or dates when the service or product was supplied, performed or completed.",
"requirements" : "Needed to determine whether the service or product was provided during the term of the insurance coverage.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.serviced[x]",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "w5",
"map" : "FiveWs.done[x]"
}
]
},
{
"id" : "Claim.item.location[x]",
"path" : "Claim.item.location[x]",
"short" : "Place of service or where product was supplied",
"definition" : "Where the product or service was provided.",
"requirements" : "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.location[x]",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServicePlace"
}
],
"strength" : "example",
"description" : "Place of service: pharmacy, school, prison, etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-place"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "w5",
"map" : "FiveWs.where[x]"
}
]
},
{
"id" : "Claim.item.quantity",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.quantity",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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<PQ>, MO, CO, depending on the values"
}
]
},
{
"id" : "Claim.item.unitPrice",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.unitPrice",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"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" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.factor",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.net",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.net",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "Claim.item.udi",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.udi",
"short" : "Unique device identifier",
"definition" : "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 allows the insurer to obtain device level information on the product supplied.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.udi",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.bodySite",
"short" : "Anatomical location",
"definition" : "Physical service site on the patient (limb, tooth, etc.).",
"comment" : "For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.bodySite",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "OralSites"
}
],
"strength" : "example",
"description" : "The code for the teeth, quadrant, sextant and arch.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.subSite",
"short" : "Anatomical sub-location",
"definition" : "A region or surface of the bodySite, e.g. 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.",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.subSite",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Surface"
}
],
"strength" : "example",
"description" : "The code for the tooth surface and surface combinations.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.encounter",
"short" : "Encounters related to this billed item",
"definition" : "The Encounters during which this Claim was created or to which the creation of this record is tightly associated.",
"comment" : "This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.",
"requirements" : "Used in some jurisdictions to link clinical events to claim items.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.encounter",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Detail"
}
],
"path" : "Claim.item.detail",
"short" : "Product or service provided",
"definition" : "A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.",
"requirements" : "The items to be processed for adjudication.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.detail",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.detail.id",
"path" : "Claim.item.detail.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.detail.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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. 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 can 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "Claim.item.detail.sequence",
"path" : "Claim.item.detail.sequence",
"short" : "Item instance identifier",
"definition" : "A number to uniquely identify item entries.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.sequence",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.detail.revenue",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.revenue",
"short" : "Revenue or cost center code",
"definition" : "The type of revenue 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.",
"requirements" : "Needed in the processing of institutional claims.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.revenue",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.category",
"short" : "Benefit classification",
"definition" : "Code to identify the general type of benefits under which products and services are provided.",
"comment" : "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
"requirements" : "Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.category",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitCategory"
}
],
"strength" : "example",
"description" : "Benefit categories such as: oral-basic, major, glasses.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-benefitcategory"
},
"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.productOrService",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"alias" : [
"Drug Code",
"Bill Code",
"Service Code"
],
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.productOrService",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.detail.modifier",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.programCode",
"short" : "Program the product or service is provided under",
"definition" : "Identifies the program under which this may be recovered.",
"comment" : "For example: Neonatal program, child dental program or drug users recovery program.",
"requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.detail.programCode",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}
],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.quantity",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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<PQ>, MO, CO, depending on the values"
}
]
},
{
"id" : "Claim.item.detail.unitPrice",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.unitPrice",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"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" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.factor",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.detail.net",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.net",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "Claim.item.detail.udi",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.udi",
"short" : "Unique device identifier",
"definition" : "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 allows the insurer to obtain device level information on the product supplied.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.detail.udi",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "SubDetail"
}
],
"path" : "Claim.item.detail.subDetail",
"short" : "Product or service provided",
"definition" : "A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.",
"requirements" : "The items to be processed for adjudication.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.detail.subDetail",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.detail.subDetail.id",
"path" : "Claim.item.detail.subDetail.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.detail.subDetail.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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. 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 can 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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.subDetail.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"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.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"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" : "Item instance identifier",
"definition" : "A number to uniquely identify item entries.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.subDetail.sequence",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.detail.subDetail.revenue",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.subDetail.revenue",
"short" : "Revenue or cost center code",
"definition" : "The type of revenue 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.",
"requirements" : "Needed in the processing of institutional claims.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.subDetail.revenue",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.subDetail.category",
"short" : "Benefit classification",
"definition" : "Code to identify the general type of benefits under which products and services are provided.",
"comment" : "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
"requirements" : "Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.subDetail.category",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitCategory"
}
],
"strength" : "example",
"description" : "Benefit categories such as: oral-basic, major, glasses.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-benefitcategory"
},
"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.productOrService",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.subDetail.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.subDetail.productOrService",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.subDetail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.detail.subDetail.modifier",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"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.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.subDetail.programCode",
"short" : "Program the product or service is provided under",
"definition" : "Identifies the program under which this may be recovered.",
"comment" : "For example: Neonatal program, child dental program or drug users recovery program.",
"requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.detail.subDetail.programCode",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}
],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"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.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.subDetail.quantity",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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<PQ>, MO, CO, depending on the values"
}
]
},
{
"id" : "Claim.item.detail.subDetail.unitPrice",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.subDetail.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.subDetail.unitPrice",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"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" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.subDetail.factor",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "Claim.item.detail.subDetail.net",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.subDetail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.item.detail.subDetail.net",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "Claim.item.detail.subDetail.udi",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.item.detail.subDetail.udi",
"short" : "Unique device identifier",
"definition" : "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 allows the insurer to obtain device level information on the product supplied.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Claim.item.detail.subDetail.udi",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"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 %rootResource.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",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "Claim.total",
"short" : "Total claim cost",
"definition" : "The total value of the all the items in the claim.",
"requirements" : "Used for control total purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Claim.total",
"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() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
}
]
},
"differential" : {
"element" : [
{
"id" : "Claim.meta",
"path" : "Claim.meta"
},
{
"id" : "Claim.meta.lastUpdated",
"path" : "Claim.meta.lastUpdated",
"mustSupport" : true
},
{
"id" : "Claim.status",
"path" : "Claim.status",
"mustSupport" : true
},
{
"id" : "Claim.type",
"path" : "Claim.type",
"mustSupport" : true
}
]
},
"text" : {
}
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.