Union of https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim and https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim

This is the set of resources that conform to either of the profiles UZ Core Claim (https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim) and UZ Core Claim (https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim). E.g. what you have to deal with if you get resources conforming to one of them

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..*Claim, Pre-determination or Pre-authorization
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: ?? (required): IETF language tag for a human language
... text 0..1NarrativeText summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
Constraints: ext-1
... identifier S0..*IdentifierBusiness Identifier for claim
... traceNumber 0..*IdentifierNumber for tracking
... status ?!SΣ1..1codeStatus of current claim
Binding: ?? (required)
... type SΣ1..1CodeableConceptCategory or discipline
Binding: ?? (required)
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
... use SΣ1..1codepreauthorization | predetermination | claim
Binding: ?? (required)
... patient SΣ1..1Reference(UZ Core Patient(0.9.0) | #sd-808-uz-core-patient-uz-core-patient)The recipient of the products and services
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created SΣ1..1dateTimeResource creation date
... enterer 0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)Author of the claim
... insurer SΣ0..1Reference(UZ Core Organization(0.9.0) | #sd-810-uz-core-organization-uz-core-organization)Target
... provider SΣ0..1Reference(UZ Core Organization(0.9.0) | #sd-810-uz-core-organization-uz-core-organization)Party responsible for the claim
... priority Σ0..1CodeableConceptDesired processing urgency
Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1CodeableConceptFor whom to reserve funds
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..*BackboneElementPrior or corollary claims
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ?? (example): Relationship of this claim to a related Claim.
.... reference 0..1IdentifierFile or case reference
... prescription S0..1Reference(UZ Core MedicationRequest(0.9.0) | #sd-908-uz-core-medicationrequest-uz-core-medicationrequest)Refers to the reimbursement prescription.
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1CodeableConceptCategory of recipient
Binding: ?? (example): A code for the party to be reimbursed.
.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral S0..1Reference(ServiceRequest)Treatment referral
... encounter 0..*Reference(Encounter)Encounters associated with the listed treatments
... facility S0..1Reference(UZ Core Location(0.9.0) | UZ Core Organization(0.9.0) | #sd-842-uz-core-location-uz-core-location)Servicing facility
... diagnosisRelatedGroup 0..1CodeableConceptPackage billing code
Binding: ?? (example)
... event 0..*BackboneElementEvent information
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1CodeableConceptSpecific event
Binding: ?? (example)
.... when[x] 1..1Occurance date or period
..... whenDateTimedateTime
..... whenPeriodPeriod
... careTeam 0..*BackboneElementMembers of the care team
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1positiveIntOrder of care team
.... provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Binding: ?? (example): The role codes for the care team members.
.... specialty 0..1CodeableConceptPractitioner or provider specialization
Binding: ?? (example)
... supportingInfo 0..*BackboneElementSupporting information
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ?? (example): The valuset used for additional information category codes.
.... code 0..1CodeableConceptType of information
Binding: ?? (example): The valuset used for additional information codes.
.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
..... valueIdentifierIdentifier
.... reason 0..1CodeableConceptExplanation for the information
Binding: ?? (example): Reason codes for the missing teeth.
... diagnosis S0..*BackboneElementPertinent diagnosis information
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] S1..1Nature of illness or problem
Binding: ?? (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1CodeableConceptPresent on admission
Binding: ?? (example): Present on admission.
... procedure 0..*BackboneElementClinical procedures performed
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1positiveIntProcedure instance identifier
.... type 0..*CodeableConceptCategory of Procedure
Binding: ?? (example): Example procedure type codes.
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
Binding: ?? (example): Example ICD10 Procedure codes.
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Unique device identifier
... insurance SΣ0..*BackboneElementPatient insurance information
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence Σ1..1positiveIntInsurance instance identifier
.... focal SΣ1..1booleanCoverage to be used for adjudication
.... identifier 0..1IdentifierPre-assigned Claim number
.... coverage SΣ1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
.... preAuthRef 0..*stringPrior authorization reference number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... accident 0..1BackboneElementDetails of the event
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... date 1..1dateWhen the incident occurred
.... type 0..1CodeableConceptThe nature of the accident
Binding: ?? (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... patientPaid 0..1MoneyPaid by the patient
... item 0..*BackboneElementProduct or service provided
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1positiveIntItem instance identifier
.... traceNumber 0..*IdentifierNumber for tracking
.... careTeamSequence 0..*positiveIntApplicable careTeam members
.... diagnosisSequence 0..*positiveIntApplicable diagnoses
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
.... productOrServiceEnd 0..1CodeableConceptEnd of a range of codes
Binding: ?? (example)
.... request 0..*Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription)Request or Referral for Service
.... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... patientPaid 0..1MoneyPaid by the patient
.... quantity 0..1??Count of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... tax 0..1MoneyTotal tax
.... net 0..1MoneyTotal item cost
.... udi 0..*Reference(Device)Unique device identifier
.... bodySite 0..*BackboneElementAnatomical location
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..*CodeableReference(BodyStructure)Location
Binding: ?? (example)
..... subSite 0..*CodeableConceptSub-location
Binding: ?? (example)
.... encounter 0..*Reference(Encounter)Encounters associated with the listed treatments
.... detail 0..*BackboneElementProduct or service provided
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... sequence 1..1positiveIntItem instance identifier
..... traceNumber 0..*IdentifierNumber for tracking
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
..... productOrServiceEnd 0..1CodeableConceptEnd of a range of codes
Binding: ?? (example)
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
..... patientPaid 0..1MoneyPaid by the patient
..... quantity 0..1??Count of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... tax 0..1MoneyTotal tax
..... net 0..1MoneyTotal item cost
..... udi 0..*Reference(Device)Unique device identifier
..... subDetail 0..*BackboneElementProduct or service provided
...... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... sequence 1..1positiveIntItem instance identifier
...... traceNumber 0..*IdentifierNumber for tracking
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
...... productOrServiceEnd 0..1CodeableConceptEnd of a range of codes
Binding: ?? (example)
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
...... patientPaid 0..1MoneyPaid by the patient
...... quantity 0..1??Count of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... tax 0..1MoneyTotal tax
...... net 0..1MoneyTotal item cost
...... udi 0..*Reference(Device)Unique device identifier
... total S0..1MoneyTotal claim cost
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... value SΣ0..1decimalNumerical value (with implicit precision)
.... currency SΣ0..1codeISO 4217 currency code
Binding: ?? (required)

doco Documentation for this format