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

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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.

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

Path	Conformance	ValueSet
Claim.language	preferred	CommonLanguages Max Binding: AllLanguages
Claim.status	required	FinancialResourceStatusCodes
Claim.type	extensible	ClaimTypeCodes
Claim.subType	example	ExampleClaimSubTypeCodes
Claim.use	required	Use
Claim.priority	example	ProcessPriorityCodes
Claim.fundsReserve	example	Funds Reservation Codes
Claim.related.relationship	example	ExampleRelatedClaimRelationshipCodes
Claim.payee.type	example	Claim Payee Type Codes
Claim.careTeam.role	example	https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-health-service-provider-role.html
Claim.careTeam.qualification	example	ExampleProviderQualificationCodes
Claim.supportingInfo.category	example	ClaimInformationCategoryCodes
Claim.supportingInfo.code	example	ExceptionCodes
Claim.supportingInfo.reason	example	MissingToothReasonCodes
Claim.diagnosis.diagnosis[x]	example	ICD-10Codes
Claim.diagnosis.type	example	ExampleDiagnosisTypeCodes
Claim.diagnosis.onAdmission	example	ExampleDiagnosisOnAdmissionCodes
Claim.diagnosis.packageCode	example	ExampleDiagnosisRelatedGroupCodes
Claim.procedure.type	example	https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-procedure-type-description.html
Claim.procedure.procedure[x]	example	https://icd.who.int/browse10/2010/en
Claim.accident.type	extensible	ActIncidentCode
Claim.item.revenue	example	ExampleRevenueCenterCodes
Claim.item.category	example	https://swasth-digital-health-foundation.github.io/standards/output/ValueSet-claim-service-categories.html
Claim.item.productOrService	example	USCLSCodes
Claim.item.modifier	example	ModifierTypeCodes
Claim.item.programCode	example	ExampleProgramReasonCodes
Claim.item.location[x]	example	ExampleServicePlaceCodes
Claim.item.bodySite	example	OralSiteCodes
Claim.item.subSite	example	SurfaceCodes
Claim.item.detail.revenue	example	ExampleRevenueCenterCodes
Claim.item.detail.category	example	BenefitCategoryCodes
Claim.item.detail.productOrService	example	USCLSCodes
Claim.item.detail.modifier	example	ModifierTypeCodes
Claim.item.detail.programCode	example	ExampleProgramReasonCodes
Claim.item.detail.subDetail.revenue	example	ExampleRevenueCenterCodes
Claim.item.detail.subDetail.category	example	BenefitCategoryCodes
Claim.item.detail.subDetail.productOrService	example	USCLSCodes
Claim.item.detail.subDetail.modifier	example	ModifierTypeCodes
Claim.item.detail.subDetail.programCode	example	ExampleProgramReasonCodes

Constraints

Id	Path	Details	Requirements
dom-2	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	Claim	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	Claim	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	Claim	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	Claim	A resource should have narrative for robust management : text.`div`.exists()
ele-1	Claim.meta	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.implicitRules	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.language	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.text	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.identifier	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.status	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.subType	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.use	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.patient	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.billablePeriod	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.created	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.enterer	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.insurer	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.provider	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.priority	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.fundsReserve	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.related	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.related.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.related.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.related.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.related.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.related.claim	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.related.relationship	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.related.reference	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.prescription	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.originalPrescription	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.payee	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.payee.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.payee.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.payee.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.payee.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.payee.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.payee.party	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.referral	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.facility	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.careTeam	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.careTeam.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.careTeam.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.careTeam.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.careTeam.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.careTeam.sequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.careTeam.provider	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.careTeam.responsible	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.careTeam.role	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.careTeam.qualification	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.supportingInfo	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.supportingInfo.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.supportingInfo.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.supportingInfo.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.supportingInfo.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.supportingInfo.sequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.supportingInfo.category	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.supportingInfo.code	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.supportingInfo.timing[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.supportingInfo.value[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.supportingInfo.reason	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.diagnosis	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.diagnosis.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.diagnosis.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.diagnosis.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.diagnosis.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.diagnosis.sequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.diagnosis.diagnosis[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.diagnosis.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.diagnosis.onAdmission	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.diagnosis.packageCode	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.procedure	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.procedure.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.procedure.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.procedure.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.procedure.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.procedure.sequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.procedure.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.procedure.date	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.procedure.procedure[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.procedure.udi	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.insurance	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.insurance.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.insurance.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.insurance.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.insurance.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.insurance.sequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.insurance.focal	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.insurance.identifier	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.insurance.coverage	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.insurance.businessArrangement	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.insurance.preAuthRef	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.insurance.claimResponse	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.accident	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.accident.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.accident.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.accident.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.accident.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.accident.date	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.accident.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.accident.location[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.item.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.item.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.item.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.item.sequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.careTeamSequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.diagnosisSequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.procedureSequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.informationSequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.revenue	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.category	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.productOrService	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.modifier	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.programCode	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.serviced[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.location[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.quantity	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.unitPrice	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.factor	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.net	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.udi	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.bodySite	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.subSite	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.encounter	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.item.detail.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.item.detail.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.item.detail.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.item.detail.sequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.revenue	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.category	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.productOrService	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.modifier	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.programCode	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.quantity	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.unitPrice	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.factor	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.net	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.udi	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.item.detail.subDetail.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.item.detail.subDetail.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Claim.item.detail.subDetail.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Claim.item.detail.subDetail.sequence	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.revenue	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.category	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.productOrService	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.modifier	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.programCode	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.quantity	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.unitPrice	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.factor	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.net	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.item.detail.subDetail.udi	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Claim.total	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())