Uzbekistan Digital Health Platform
0.7.0 - ci-build Uzbekistan flag

Uzbekistan Digital Health Platform - Local Development build (v0.7.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: UZ Core Claim ( Experimental )

Official URL: https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim Version: 0.7.0
Draft as of 2026-06-22 Computable Name: UZCoreClaim

Uzbekistan Core Claim profile, used for insurance claims, pre-authorization and predetermination processes.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim(5.0.0) Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!SΣ 1..1 code Status of current claim
Binding: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeVS (0.7.0) (required)
... use SΣ 1..1 code preauthorization | predetermination | claim
Binding: ClaimUseVS (0.7.0) (required)
... patient SΣ 1..1 Reference(UZ Core Patient(0.7.0)) The recipient of the products and services
... created SΣ 1..1 dateTime Resource creation date
... insurer SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Target
... provider SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Party responsible for the claim
... prescription S 0..1 Reference(MedicationRequest) Refers to the reimbursement prescription.
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(UZ Core Location(0.7.0) | UZ Core Organization(0.7.0)) Servicing facility
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 Nature of illness or problem
Binding: ICD10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
... insurance SΣ 0..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
... total S 0..1 Money Total claim cost
.... value SΣ 0..1 decimal Numerical value (with implicit precision)
.... currency SΣ 0..1 code ISO 4217 currency code
Binding: Currencies (required)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.status Base required Financial Management Status Value set 📍0.7.0 This IG
Claim.type Base required Claim Type VS 📍0.7.0 This IG
Claim.use Base required Claim Use Value set 📍0.7.0 This IG
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍5.0.0 FHIR Std.
Claim.total.currency Base required Currencies 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim(5.0.0) Claim, Pre-determination or Pre-authorization
... identifier S 0..* Identifier Business Identifier for claim
... status S 1..1 code Status of current claim
Binding: FMStatusVS (0.7.0) (required)
... type S 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeVS (0.7.0) (required)
... patient S 1..1 Reference(UZ Core Patient(0.7.0)) The recipient of the products and services
... created S 1..1 dateTime Resource creation date
... insurer S 0..1 Reference(UZ Core Organization(0.7.0)) Target
... provider S 0..1 Reference(UZ Core Organization(0.7.0)) Party responsible for the claim
... prescription S 0..1 Reference(MedicationRequest) Refers to the reimbursement prescription.
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(UZ Core Location(0.7.0) | UZ Core Organization(0.7.0)) Servicing facility
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... diagnosis[x] S 1..1 CodeableConcept, Reference(Condition) Nature of illness or problem
... insurance S 0..* BackboneElement Patient insurance information
.... focal S 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Coverage) Insurance information
... total S 0..1 Money Total claim cost
.... value S 0..1 decimal Numerical value (with implicit precision)
.... currency S 0..1 code ISO 4217 currency code
Binding: Currencies (required)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.status Base required Financial Management Status Value set 📍0.7.0 This IG
Claim.type Base required Claim Type VS 📍0.7.0 This IG
Claim.use Base required Claim Use Value set 📍0.7.0 This IG
Claim.total.currency Base required Currencies 📍5.0.0 FHIR Std.
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim(5.0.0) Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text 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..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier S 0..* Identifier Business Identifier for claim
... traceNumber 0..* Identifier Number for tracking
... status ?!SΣ 1..1 code Status of current claim
Binding: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeVS (0.7.0) (required)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code preauthorization | predetermination | claim
Binding: ClaimUseVS (0.7.0) (required)
... patient SΣ 1..1 Reference(UZ Core Patient(0.7.0)) The recipient of the products and services
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) Author of the claim
... insurer SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Target
... provider SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Party responsible for the claim
... priority Σ 0..1 CodeableConcept Desired processing urgency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription S 0..1 Reference(MedicationRequest) Refers to the reimbursement prescription.
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Category of recipient
Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
... facility S 0..1 Reference(UZ Core Location(0.7.0) | UZ Core Organization(0.7.0)) Servicing facility
... diagnosisRelatedGroup 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
... event 0..* BackboneElement Event information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Specific event
Binding: DatesTypeCodes (example)
.... when[x] 1..1 Occurance date or period
..... whenDateTime dateTime
..... whenPeriod Period
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... specialty 0..1 CodeableConcept Practitioner or provider specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... valueIdentifier Identifier
.... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 Nature of illness or problem
Binding: ICD10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance SΣ 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... patientPaid 0..1 Money Paid by the patient
... item 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Item instance identifier
.... traceNumber 0..* Identifier Number for tracking
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... patientPaid 0..1 Money Paid by the patient
.... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... tax 0..1 Money Total tax
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..* BackboneElement Anatomical location
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..* CodeableReference(BodyStructure) Location
Binding: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
.... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... sequence 1..1 positiveInt Item instance identifier
..... traceNumber 0..* Identifier Number for tracking
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... patientPaid 0..1 Money Paid by the patient
..... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... tax 0..1 Money Total tax
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... sequence 1..1 positiveInt Item instance identifier
...... traceNumber 0..* Identifier Number for tracking
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... patientPaid 0..1 Money Paid by the patient
...... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... tax 0..1 Money Total tax
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total S 0..1 Money Total claim cost
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
.... value SΣ 0..1 decimal Numerical value (with implicit precision)
.... currency SΣ 0..1 code ISO 4217 currency code
Binding: Currencies (required)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base required All Languages 📍5.0.0 FHIR Std.
Claim.status Base required Financial Management Status Value set 📍0.7.0 This IG
Claim.type Base required Claim Type VS 📍0.7.0 This IG
Claim.subType Base example Example Claim SubType Codes 📍5.0.0 FHIR Std.
Claim.use Base required Claim Use Value set 📍0.7.0 This IG
Claim.priority Base example Process Priority Codes 📍5.0.0 FHIR Std.
Claim.fundsReserve Base example Funds Reservation Codes 📍5.0.0 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍5.0.0 FHIR Std.
Claim.payee.type Base example Claim Payee Type Codes 📍5.0.0 FHIR Std.
Claim.diagnosisRelatedGroup Base example Example Diagnosis Related Group Codes 📍5.0.0 FHIR Std.
Claim.event.type Base example Dates Type Codes 📍5.0.0 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍5.0.0 FHIR Std.
Claim.careTeam.specialty Base example Example Provider Qualification Codes 📍5.0.0 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍5.0.0 FHIR Std.
Claim.supportingInfo.​code Base example Exception Codes 📍5.0.0 FHIR Std.
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍5.0.0 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍5.0.0 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍5.0.0 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍5.0.0 FHIR Std.
Claim.procedure.type Base example Example Procedure Type Codes 📍5.0.0 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍5.0.0 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📍3.0.0 THO v7.3
Claim.item.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍5.0.0 FHIR Std.
Claim.item.bodySite.​site Base example Oral Site Codes 📍5.0.0 FHIR Std.
Claim.item.bodySite.​subSite Base example Surface Codes 📍5.0.0 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
Claim.total.currency Base required Currencies 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim(5.0.0) Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!SΣ 1..1 code Status of current claim
Binding: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeVS (0.7.0) (required)
... use SΣ 1..1 code preauthorization | predetermination | claim
Binding: ClaimUseVS (0.7.0) (required)
... patient SΣ 1..1 Reference(UZ Core Patient(0.7.0)) The recipient of the products and services
... created SΣ 1..1 dateTime Resource creation date
... insurer SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Target
... provider SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Party responsible for the claim
... prescription S 0..1 Reference(MedicationRequest) Refers to the reimbursement prescription.
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(UZ Core Location(0.7.0) | UZ Core Organization(0.7.0)) Servicing facility
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 Nature of illness or problem
Binding: ICD10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
... insurance SΣ 0..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
... total S 0..1 Money Total claim cost
.... value SΣ 0..1 decimal Numerical value (with implicit precision)
.... currency SΣ 0..1 code ISO 4217 currency code
Binding: Currencies (required)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.status Base required Financial Management Status Value set 📍0.7.0 This IG
Claim.type Base required Claim Type VS 📍0.7.0 This IG
Claim.use Base required Claim Use Value set 📍0.7.0 This IG
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍5.0.0 FHIR Std.
Claim.total.currency Base required Currencies 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim(5.0.0) Claim, Pre-determination or Pre-authorization
... identifier S 0..* Identifier Business Identifier for claim
... status S 1..1 code Status of current claim
Binding: FMStatusVS (0.7.0) (required)
... type S 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeVS (0.7.0) (required)
... patient S 1..1 Reference(UZ Core Patient(0.7.0)) The recipient of the products and services
... created S 1..1 dateTime Resource creation date
... insurer S 0..1 Reference(UZ Core Organization(0.7.0)) Target
... provider S 0..1 Reference(UZ Core Organization(0.7.0)) Party responsible for the claim
... prescription S 0..1 Reference(MedicationRequest) Refers to the reimbursement prescription.
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... facility S 0..1 Reference(UZ Core Location(0.7.0) | UZ Core Organization(0.7.0)) Servicing facility
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... diagnosis[x] S 1..1 CodeableConcept, Reference(Condition) Nature of illness or problem
... insurance S 0..* BackboneElement Patient insurance information
.... focal S 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Coverage) Insurance information
... total S 0..1 Money Total claim cost
.... value S 0..1 decimal Numerical value (with implicit precision)
.... currency S 0..1 code ISO 4217 currency code
Binding: Currencies (required)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.status Base required Financial Management Status Value set 📍0.7.0 This IG
Claim.type Base required Claim Type VS 📍0.7.0 This IG
Claim.use Base required Claim Use Value set 📍0.7.0 This IG
Claim.total.currency Base required Currencies 📍5.0.0 FHIR Std.

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim(5.0.0) Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text 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..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier S 0..* Identifier Business Identifier for claim
... traceNumber 0..* Identifier Number for tracking
... status ?!SΣ 1..1 code Status of current claim
Binding: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeVS (0.7.0) (required)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code preauthorization | predetermination | claim
Binding: ClaimUseVS (0.7.0) (required)
... patient SΣ 1..1 Reference(UZ Core Patient(0.7.0)) The recipient of the products and services
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) Author of the claim
... insurer SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Target
... provider SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Party responsible for the claim
... priority Σ 0..1 CodeableConcept Desired processing urgency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription S 0..1 Reference(MedicationRequest) Refers to the reimbursement prescription.
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Category of recipient
Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral S 0..1 Reference(ServiceRequest) Treatment referral
... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
... facility S 0..1 Reference(UZ Core Location(0.7.0) | UZ Core Organization(0.7.0)) Servicing facility
... diagnosisRelatedGroup 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
... event 0..* BackboneElement Event information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Specific event
Binding: DatesTypeCodes (example)
.... when[x] 1..1 Occurance date or period
..... whenDateTime dateTime
..... whenPeriod Period
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... specialty 0..1 CodeableConcept Practitioner or provider specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... valueIdentifier Identifier
.... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis S 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] S 1..1 Nature of illness or problem
Binding: ICD10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance SΣ 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal SΣ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage SΣ 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... patientPaid 0..1 Money Paid by the patient
... item 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Item instance identifier
.... traceNumber 0..* Identifier Number for tracking
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... patientPaid 0..1 Money Paid by the patient
.... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... tax 0..1 Money Total tax
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..* BackboneElement Anatomical location
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..* CodeableReference(BodyStructure) Location
Binding: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
.... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... sequence 1..1 positiveInt Item instance identifier
..... traceNumber 0..* Identifier Number for tracking
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... patientPaid 0..1 Money Paid by the patient
..... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... tax 0..1 Money Total tax
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... sequence 1..1 positiveInt Item instance identifier
...... traceNumber 0..* Identifier Number for tracking
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... patientPaid 0..1 Money Paid by the patient
...... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... tax 0..1 Money Total tax
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total S 0..1 Money Total claim cost
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
.... value SΣ 0..1 decimal Numerical value (with implicit precision)
.... currency SΣ 0..1 code ISO 4217 currency code
Binding: Currencies (required)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base required All Languages 📍5.0.0 FHIR Std.
Claim.status Base required Financial Management Status Value set 📍0.7.0 This IG
Claim.type Base required Claim Type VS 📍0.7.0 This IG
Claim.subType Base example Example Claim SubType Codes 📍5.0.0 FHIR Std.
Claim.use Base required Claim Use Value set 📍0.7.0 This IG
Claim.priority Base example Process Priority Codes 📍5.0.0 FHIR Std.
Claim.fundsReserve Base example Funds Reservation Codes 📍5.0.0 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍5.0.0 FHIR Std.
Claim.payee.type Base example Claim Payee Type Codes 📍5.0.0 FHIR Std.
Claim.diagnosisRelatedGroup Base example Example Diagnosis Related Group Codes 📍5.0.0 FHIR Std.
Claim.event.type Base example Dates Type Codes 📍5.0.0 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍5.0.0 FHIR Std.
Claim.careTeam.specialty Base example Example Provider Qualification Codes 📍5.0.0 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍5.0.0 FHIR Std.
Claim.supportingInfo.​code Base example Exception Codes 📍5.0.0 FHIR Std.
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍5.0.0 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍5.0.0 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍5.0.0 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍5.0.0 FHIR Std.
Claim.procedure.type Base example Example Procedure Type Codes 📍5.0.0 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍5.0.0 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📍3.0.0 THO v7.3
Claim.item.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍5.0.0 FHIR Std.
Claim.item.bodySite.​site Base example Oral Site Codes 📍5.0.0 FHIR Std.
Claim.item.bodySite.​subSite Base example Surface Codes 📍5.0.0 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
Claim.total.currency Base required Currencies 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

 

Other representations of profile: CSV, Excel, Schematron