FHIR Implementation Guide for HCX
0.0.1 - CI Build

FHIR Implementation Guide for HCX - Local Development build (v0.0.1). See the Directory of published versions

Resource Profile: HCX Claim

Defining URL:http://hl7.org/fhir/StructureDefinition/HCXClaim
Version:0.0.1
Name:Claim
Status:Draft as of 2019-11-01T09:29:23+11:00 (Standards Status: Trial Use)
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. test1487

Publisher:HL7 International - HCX
Committee:Financial Management
Maturity:2
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://hl7.org/fhir/StructureDefinition/HCXClaim

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Claim

Summary

Mandatory: 5 elements (2 nested mandatory elements)

Maturity: 2

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*ClaimClaim, Pre-determination or Pre-authorization
... identifier 1..*IdentifierBusiness Identifier for claim
... insurer Σ1..1Reference(Organization)Target
... payee 1..1BackboneElementRecipient of benefits payable
.... party 1..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
.... role 0..1CodeableConceptFunction within the team
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-health-service-provider-role.html (example): The role codes for the care team members.

... diagnosis
.... type 1..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


... procedure
.... type 0..*CodeableConceptCategory of Procedure
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-procedure-type-description.html (example): Example procedure type codes.


.... procedure[x] 1..1Specific clinical procedure
Binding: https://icd.who.int/browse10/2010/en (example): Procedure codes.

..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
... item
.... category 0..1CodeableConceptBenefit classification
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-claim-service-categories.html (example): Benefit categories such as: oral-basic, major, glasses.


doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*ClaimClaim, 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: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 1..*IdentifierBusiness Identifier for claim
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType 0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient Σ1..1Reference(Patient)The recipient of the products and services
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created Σ1..1dateTimeResource creation date
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer Σ1..1Reference(Organization)Target
... provider Σ1..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... priority Σ1..1CodeableConceptDesired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... fundsReserve 0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..*BackboneElementPrior or corollary claims
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Prescription authorizing services and products
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee 1..1BackboneElementRecipient of benefits payable
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 1..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Treatment referral
... facility 0..1Reference(Location)Servicing facility
... careTeam 1..*BackboneElementMembers of the care team
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... 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: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-health-service-provider-role.html (example): The role codes for the care team members.

.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo 0..*BackboneElementSupporting information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code 0..1CodeableConceptType of information
Binding: ExceptionCodes (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)
.... reason 0..1CodeableConceptExplanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis 0..*BackboneElementPertinent diagnosis information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 1..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission 0..1CodeableConceptPresent on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1CodeableConceptPackage billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 0..*BackboneElementClinical procedures performed
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntProcedure instance identifier
.... type 0..*CodeableConceptCategory of Procedure
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-procedure-type-description.html (example): Example procedure type codes.


.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
Binding: https://icd.who.int/browse10/2010/en (example): Procedure codes.

..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Unique device identifier
... insurance Σ1..*BackboneElementPatient insurance information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ1..1positiveIntInsurance instance identifier
.... focal Σ1..1booleanCoverage to be used for adjudication
.... identifier 0..1IdentifierPre-assigned Claim number
.... coverage Σ1..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
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date 1..1dateWhen the incident occurred
.... type 0..1CodeableConceptThe nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item 0..*BackboneElementProduct or service provided
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntItem instance identifier
.... 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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

.... category 0..1CodeableConceptBenefit classification
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-claim-service-categories.html (example): Benefit categories such as: oral-basic, major, glasses.

.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..*CodeableConceptProduct 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..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (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: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... udi 0..*Reference(Device)Unique device identifier
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..*Reference(Encounter)Encounters related to this billed item
.... detail 0..*BackboneElementProduct or service provided
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntItem instance identifier
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptService/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..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... 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
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence 1..1positiveIntItem instance identifier
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*CodeableConceptService/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..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity 0..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... udi 0..*Reference(Device)Unique device identifier
... total 0..1MoneyTotal claim cost

doco Documentation for this format

This structure is derived from Claim

Summary

Mandatory: 5 elements (2 nested mandatory elements)

Maturity: 2

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*ClaimClaim, Pre-determination or Pre-authorization
... identifier 1..*IdentifierBusiness Identifier for claim
... insurer Σ1..1Reference(Organization)Target
... payee 1..1BackboneElementRecipient of benefits payable
.... party 1..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
.... role 0..1CodeableConceptFunction within the team
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-health-service-provider-role.html (example): The role codes for the care team members.

... diagnosis
.... type 1..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


... procedure
.... type 0..*CodeableConceptCategory of Procedure
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-procedure-type-description.html (example): Example procedure type codes.


.... procedure[x] 1..1Specific clinical procedure
Binding: https://icd.who.int/browse10/2010/en (example): Procedure codes.

..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
... item
.... category 0..1CodeableConceptBenefit classification
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-claim-service-categories.html (example): Benefit categories such as: oral-basic, major, glasses.


doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*ClaimClaim, 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: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 1..*IdentifierBusiness Identifier for claim
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType 0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.

... patient Σ1..1Reference(Patient)The recipient of the products and services
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created Σ1..1dateTimeResource creation date
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer Σ1..1Reference(Organization)Target
... provider Σ1..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... priority Σ1..1CodeableConceptDesired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

... fundsReserve 0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..*BackboneElementPrior or corollary claims
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Prescription authorizing services and products
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee 1..1BackboneElementRecipient of benefits payable
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 1..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Treatment referral
... facility 0..1Reference(Location)Servicing facility
... careTeam 1..*BackboneElementMembers of the care team
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... 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: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-health-service-provider-role.html (example): The role codes for the care team members.

.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo 0..*BackboneElementSupporting information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code 0..1CodeableConceptType of information
Binding: ExceptionCodes (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)
.... reason 0..1CodeableConceptExplanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis 0..*BackboneElementPertinent diagnosis information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 1..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission 0..1CodeableConceptPresent on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1CodeableConceptPackage billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 0..*BackboneElementClinical procedures performed
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntProcedure instance identifier
.... type 0..*CodeableConceptCategory of Procedure
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-procedure-type-description.html (example): Example procedure type codes.


.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
Binding: https://icd.who.int/browse10/2010/en (example): Procedure codes.

..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Unique device identifier
... insurance Σ1..*BackboneElementPatient insurance information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ1..1positiveIntInsurance instance identifier
.... focal Σ1..1booleanCoverage to be used for adjudication
.... identifier 0..1IdentifierPre-assigned Claim number
.... coverage Σ1..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
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date 1..1dateWhen the incident occurred
.... type 0..1CodeableConceptThe nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item 0..*BackboneElementProduct or service provided
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntItem instance identifier
.... 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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

.... category 0..1CodeableConceptBenefit classification
Binding: https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-claim-service-categories.html (example): Benefit categories such as: oral-basic, major, glasses.

.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..*CodeableConceptProduct 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..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (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: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... udi 0..*Reference(Device)Unique device identifier
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..*Reference(Encounter)Encounters related to this billed item
.... detail 0..*BackboneElementProduct or service provided
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntItem instance identifier
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptService/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..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... 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
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence 1..1positiveIntItem instance identifier
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*CodeableConceptService/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..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity 0..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... udi 0..*Reference(Device)Unique device identifier
... total 0..1MoneyTotal claim cost

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
Claim.languagepreferredCommonLanguages
Max Binding: AllLanguages
Claim.statusrequiredFinancialResourceStatusCodes
Claim.typeextensibleClaimTypeCodes
Claim.subTypeexampleExampleClaimSubTypeCodes
Claim.userequiredUse
Claim.priorityexampleProcessPriorityCodes
Claim.fundsReserveexampleFunds Reservation Codes
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
Claim.payee.typeexampleClaim Payee Type Codes
Claim.careTeam.roleexamplehttps://swasth-digital-health-foundation.github.io/standards/output/ValueSet-health-service-provider-role.html
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
Claim.supportingInfo.codeexampleExceptionCodes
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
Claim.procedure.typeexamplehttps://swasth-digital-health-foundation.github.io/standards/output/ValueSet-procedure-type-description.html
Claim.procedure.procedure[x]examplehttps://icd.who.int/browse10/2010/en
Claim.accident.typeextensibleActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
Claim.item.categoryexamplehttps://swasth-digital-health-foundation.github.io/standards/output/ValueSet-claim-service-categories.html
Claim.item.productOrServiceexampleUSCLSCodes
Claim.item.modifierexampleModifierTypeCodes
Claim.item.programCodeexampleExampleProgramReasonCodes
Claim.item.location[x]exampleExampleServicePlaceCodes
Claim.item.bodySiteexampleOralSiteCodes
Claim.item.subSiteexampleSurfaceCodes
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
Claim.item.detail.categoryexampleBenefitCategoryCodes
Claim.item.detail.productOrServiceexampleUSCLSCodes
Claim.item.detail.modifierexampleModifierTypeCodes
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes

Constraints

IdPathDetailsRequirements
dom-2ClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3ClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: 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()
dom-4ClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5ClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6ClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1Claim.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.subTypeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.patientAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.billablePeriodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.createdAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.entererAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.priorityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.fundsReserveAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.relatedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.related.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.related.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.related.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.related.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.related.claimAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.related.relationshipAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.related.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.prescriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.originalPrescriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.payeeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.payee.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.payee.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.payee.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.payee.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.payee.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.payee.partyAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.referralAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.facilityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeamAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.careTeam.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.careTeam.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.careTeam.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.careTeam.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.responsibleAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.roleAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.careTeam.qualificationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfoAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.supportingInfo.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.supportingInfo.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.supportingInfo.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.supportingInfo.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.timing[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.supportingInfo.reasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosisAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.diagnosis.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.diagnosis.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.diagnosis.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.diagnosis.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.diagnosis[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.onAdmissionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.diagnosis.packageCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedureAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.procedure.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.procedure.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.procedure.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.procedure.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.procedure[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.procedure.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insuranceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.insurance.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.insurance.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.insurance.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.insurance.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.focalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.coverageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.businessArrangementAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.preAuthRefAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.insurance.claimResponseAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accidentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accident.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.accident.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.accident.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.accident.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.accident.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accident.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.accident.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.itemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.careTeamSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.diagnosisSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.procedureSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.informationSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.serviced[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.bodySiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.subSiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.encounterAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.subDetail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.subDetail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Claim.item.detail.subDetail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Claim.item.detail.subDetail.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.item.detail.subDetail.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Claim.totalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())