HL7.FHIR.IN.CORE\HCX Claim Request Document

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

Resource Profile: HCX Claim Request Document

Defining URL:

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

Version:

0.0.1

Name:

ClaimRequestDocument

Status:

Draft as of 2021-08-14T17:23:00.000+05:30 (Standards Status: Trial Use)

Definition:

This profile sets minimum expectations for the Claim Request document to exchange the financial information, and supporting clinical information, regarding the provision of health care services with payors. It identifies the mandatory core elements, vocabularies and value sets which SHALL be present in the Composition resource when using this profile.

Publisher:

HL7 International - HCX

Committee:

Structured Documents

Maturity:

Source Resource:

XML / JSON / Turtle

The official URL for this profile is:

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

Formal Views of Profile Content

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

Text Summary
Differential Table
Snapshot Table
Snapshot Table (Must Support)
All

This structure is derived from Composition

Summary

Mandatory: 3 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

https://swasth-digital-health-foundation.github.io/standards/output/StructureDefinition-HCXSignature.html

Slices

This structure defines the following Slices:

The element Composition.section.entry is sliced based on the value of value:url

Maturity: 2

This structure is derived from Composition

Name	Card.	Type	Description & Constraints
Composition	0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
type	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (required): Type of a composition. TODO - Value set of all HCX objects.
section	1..1	BackboneElement	Composition is broken into sections
code	0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required): TODO - value set listing all HCX eObjects including Claim for this one. Fixed Value: As shown
text	1..1	string	Plain text representation of the concept Fixed Value: Claim
Slices for entry	1..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by value:url
entry:claim	1..1	Reference(Claim)	A reference to the claim that the pre-auth request refers to.
entry:signature	0..*	Reference(HCX Signature)	A reference to the claim that the pre-auth request refers to.
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
id	Σ	0..1	string	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: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary \| final \| amended \| entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	Σ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (required): Type of a composition. TODO - Value set of all HCX objects.
category	Σ	0..*	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	Σ	0..1	Reference(Resource)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(Encounter)	Context of the Composition
date	Σ	1..1	dateTime	Composition editing time
author	Σ	1..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the composition
title	Σ	1..1	string	Human Readable name/title
confidentiality	Σ	0..1	code	As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition.
attester		0..*	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal \| professional \| legal \| official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole \| Organization)	Who attested the composition
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces \| transforms \| signs \| appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	The period covered by the documentation
detail	Σ	0..*	Reference(Resource)	The event(s) being documented
section	I	1..1	BackboneElement	Composition is broken into sections
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required): TODO - value set listing all HCX eObjects including Claim for this one. Fixed Value: As shown
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		0..0	Coding	Code defined by a terminology system
text		1..1	string	Plain text representation of the concept Fixed Value: Claim
author		0..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	I	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working \| snapshot \| changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	I	1..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by value:url
entry:claim	I	1..1	Reference(Claim)	A reference to the claim that the pre-auth request refers to.
entry:signature	I	0..*	Reference(HCX Signature)	A reference to the claim that the pre-auth request refers to.
emptyReason	I	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	I	0..*	See section (Composition)	Nested Section
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
Documentation for this format

This structure is derived from Composition

Summary

Mandatory: 3 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

https://swasth-digital-health-foundation.github.io/standards/output/StructureDefinition-HCXSignature.html

Slices

This structure defines the following Slices:

The element Composition.section.entry is sliced based on the value of value:url

Maturity: 2

Differential View

This structure is derived from Composition

Name	Card.	Type	Description & Constraints
Composition	0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
type	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (required): Type of a composition. TODO - Value set of all HCX objects.
section	1..1	BackboneElement	Composition is broken into sections
code	0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required): TODO - value set listing all HCX eObjects including Claim for this one. Fixed Value: As shown
text	1..1	string	Plain text representation of the concept Fixed Value: Claim
Slices for entry	1..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by value:url
entry:claim	1..1	Reference(Claim)	A reference to the claim that the pre-auth request refers to.
entry:signature	0..*	Reference(HCX Signature)	A reference to the claim that the pre-auth request refers to.
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
id	Σ	0..1	string	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: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary \| final \| amended \| entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	Σ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (required): Type of a composition. TODO - Value set of all HCX objects.
category	Σ	0..*	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	Σ	0..1	Reference(Resource)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(Encounter)	Context of the Composition
date	Σ	1..1	dateTime	Composition editing time
author	Σ	1..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the composition
title	Σ	1..1	string	Human Readable name/title
confidentiality	Σ	0..1	code	As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition.
attester		0..*	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal \| professional \| legal \| official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole \| Organization)	Who attested the composition
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces \| transforms \| signs \| appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	The period covered by the documentation
detail	Σ	0..*	Reference(Resource)	The event(s) being documented
section	I	1..1	BackboneElement	Composition is broken into sections
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required): TODO - value set listing all HCX eObjects including Claim for this one. Fixed Value: As shown
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		0..0	Coding	Code defined by a terminology system
text		1..1	string	Plain text representation of the concept Fixed Value: Claim
author		0..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	I	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working \| snapshot \| changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	I	1..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by value:url
entry:claim	I	1..1	Reference(Claim)	A reference to the claim that the pre-auth request refers to.
entry:signature	I	0..*	Reference(HCX Signature)	A reference to the claim that the pre-auth request refers to.
emptyReason	I	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	I	0..*	See section (Composition)	Nested Section
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

Path	Conformance	ValueSet / Code
Composition.language	preferred	CommonLanguages Max Binding: AllLanguages
Composition.status	required	CompositionStatus
Composition.type	required	FHIRDocumentTypeCodes
Composition.category	example	DocumentClassValueSet
Composition.confidentiality	required	v3.ConfidentialityClassification
Composition.attester.mode	required	CompositionAttestationMode
Composition.relatesTo.code	required	DocumentRelationshipType
Composition.event.code	example	ActCode
Composition.section.code	required	Fixed Value: "Claim"
Composition.section.mode	required	ListMode
Composition.section.orderedBy	preferred	ListOrderCodes
Composition.section.emptyReason	preferred	ListEmptyReasons

Constraints

Id	Path	Details	Requirements
dom-2	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	Composition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : 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-4	Composition	If 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-5	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	Composition.meta	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.implicitRules	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.language	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.text	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.identifier	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.status	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.category	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.subject	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.encounter	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.date	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.author	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.title	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.confidentiality	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.attester	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.attester.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.attester.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.attester.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.attester.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.attester.mode	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.attester.time	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.attester.party	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.custodian	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.relatesTo	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.relatesTo.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.relatesTo.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.relatesTo.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.relatesTo.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.relatesTo.code	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.relatesTo.target[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.event	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.event.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.event.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.event.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.event.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.event.code	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.event.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.event.detail	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
cmp-1	Composition.section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	Composition.section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
ele-1	Composition.section	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.section.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.section.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.section.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.section.title	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.code	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.author	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.focus	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.text	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.mode	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.orderedBy	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.entry	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.entry:claim	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.entry:signature	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.emptyReason	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.section	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())