Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
Σ | DomainResource | Claim, Pre-determination or Pre-authorization | ||
Σ | 1..1 | code | institutional | oral | pharmacy | professional | vision ClaimType (Required) | |
Σ | 0..* | Coding | Finer grained claim type information Example Claim SubType Codes (Example) | |
Σ | 0..* | Identifier | Claim number | |
Σ | 0..1 | Coding | Current specification followed Ruleset Codes (Example) | |
Σ | 0..1 | Coding | Original specification followed Ruleset Codes (Example) | |
Σ | 0..1 | dateTime | Creation date | |
Σ | 0..1 | Period | Period for charge submission | |
Σ | 0..1 | Insurer | ||
Identifier | ||||
Reference(Organization) | ||||
Σ | 0..1 | Responsible provider | ||
Identifier | ||||
Reference(Practitioner) | ||||
Σ | 0..1 | Responsible organization | ||
Identifier | ||||
Reference(Organization) | ||||
Σ | 0..1 | code | complete | proposed | exploratory | other Use (Required) | |
Σ | 0..1 | Coding | Desired processing priority Priority Codes (Example) | |
Σ | 0..1 | Coding | Funds requested to be reserved Funds Reservation Codes (Example) | |
Σ | 0..1 | Author | ||
Identifier | ||||
Reference(Practitioner) | ||||
Σ | 0..1 | Servicing Facility | ||
Identifier | ||||
Reference(Location) | ||||
Σ | 0..* | BackboneElement | Related Claims which may be revelant to processing this claimn | |
Σ | 0..1 | Reference to the related claim | ||
Identifier | ||||
Reference(Claim) | ||||
Σ | 0..1 | Coding | How the reference claim is related Example Related Claim Relationship Codes (Example) | |
Σ | 0..1 | Identifier | Related file or case reference | |
Σ | 0..1 | Prescription | ||
Identifier | ||||
Reference(MedicationOrder | VisionPrescription) | ||||
Σ | 0..1 | Original Prescription | ||
Identifier | ||||
Reference(MedicationOrder) | ||||
Σ | 0..1 | BackboneElement | Party to be paid any benefits payable | |
Σ | 1..1 | Coding | Type of party: Subscriber, Provider, other Payee Type Codes (Example) | |
Σ | 0..1 | Party to receive the payable | ||
Identifier | ||||
Reference(Practitioner | Organization | Patient | RelatedPerson) | ||||
Σ | 0..1 | Treatment Referral | ||
Identifier | ||||
Reference(ReferralRequest) | ||||
Σ | 0..* | Coding | Occurrence Codes Example Occurrance Codes (Example) | |
Σ | 0..* | Coding | Occurrence Span Codes Example Occurrance Span Codes (Example) | |
Σ | 0..* | Coding | Value Codes Example Value Codes (Example) | |
Σ | 0..* | BackboneElement | Diagnosis | |
Σ | 1..1 | positiveInt | Number to covey order of diagnosis | |
Σ | 1..1 | Coding | Patient's list of diagnosis ICD-10 Codes (Example) | |
Σ | 0..* | BackboneElement | Procedures performed | |
Σ | 1..1 | positiveInt | Procedure sequence for reference | |
Σ | 0..1 | dateTime | When the procedure was performed | |
Σ | 1..1 | Patient's list of procedures performed ICD-10 Procedure Codes (Example) | ||
Coding | ||||
Reference(Procedure) | ||||
Σ | 0..* | Coding | List of special Conditions Conditions Codes (Example) | |
Σ | 1..1 | The subject of the Products and Services | ||
Identifier | ||||
Reference(Patient) | ||||
Σ | 0..* | BackboneElement | Insurance or medical plan | |
Σ | 1..1 | positiveInt | Service instance identifier | |
Σ | 1..1 | boolean | Is the focal Coverage | |
Σ | 1..1 | Insurance information | ||
Identifier | ||||
Reference(Coverage) | ||||
Σ | 0..1 | string | Business agreement | |
Σ | 0..* | string | Pre-Authorization/Determination Reference | |
Σ | 0..1 | Reference(ClaimResponse) | Adjudication results | |
Σ | 0..1 | Coding | Original version Ruleset Codes (Example) | |
Σ | 0..1 | date | When the accident occurred | |
Σ | 0..1 | Coding | The nature of the accident ActIncidentCode (Required) | |
Σ | 0..1 | Accident Place | ||
Address | ||||
Reference(Location) | ||||
Σ | 0..* | Coding | Intervention and exception code (Pharma) Intervention Codes (Example) | |
Σ | 0..* | BackboneElement | Condition related Onset related dates and codes | |
Σ | 0..1 | Illness, injury or treatable condition date | ||
date | ||||
Period | ||||
Σ | 0..1 | Coding | Onset of what Example Onset Type (Reason) Codes (Example) | |
Σ | 0..1 | Period | Period unable to work | |
Σ | 0..1 | Period | Period in hospital | |
Σ | 0..* | BackboneElement | Goods and Services | |
Σ | 1..1 | positiveInt | Service instance | |
Σ | 1..1 | Coding | Group or type of product or service Exception Codes (Required) | |
Σ | 0..1 | Responsible practitioner | ||
Identifier | ||||
Reference(Practitioner) | ||||
Σ | 0..1 | Supervising Practitioner | ||
Identifier | ||||
Reference(Practitioner) | ||||
Σ | 0..1 | Coding | Type, classification or Specialization Example Provider Qualification Codes (Example) | |
Σ | 0..* | positiveInt | Applicable diagnoses | |
Σ | 1..1 | Coding | Item Code USCLS Codes (Example) | |
Σ | 0..* | Coding | Service/Product modifiers Example Service Modifier Codes (Example) | |
Σ | 0..* | Coding | Service/Product billing modifiers Modifier type Codes (Example) | |
Σ | 0..* | Coding | Program specific reason for item inclusion Example Program Reason Codes (Example) | |
Σ | 0..1 | Date or dates of Service | ||
date | ||||
Period | ||||
Σ | 0..1 | Coding | Place of service Example Service Place Codes (Example) | |
Σ | 0..1 | SimpleQuantity | Count of Products or Services | |
Σ | 0..1 | Money | Fee, charge or cost per point | |
Σ | 0..1 | decimal | Price scaling factor | |
Σ | 0..1 | decimal | Difficulty scaling factor | |
Σ | 0..1 | Money | Total item cost | |
Σ | 0..* | Reference(Device) | Unique Device Identifier | |
Σ | 0..1 | Coding | Service Location Oral Site Codes (Example) | |
Σ | 0..* | Coding | Service Sub-location Surface Codes (Example) | |
Σ | 0..* | BackboneElement | Additional items | |
Σ | 1..1 | positiveInt | Service instance | |
Σ | 1..1 | Coding | Group or type of product or service Exception Codes (Required) | |
Σ | 1..1 | Coding | Additional item codes USCLS Codes (Example) | |
Σ | 0..* | Coding | Program specific reason for item inclusion Example Program Reason Codes (Example) | |
Σ | 0..1 | SimpleQuantity | Count of Products or Services | |
Σ | 0..1 | Money | Fee, charge or cost per point | |
Σ | 0..1 | decimal | Price scaling factor | |
Σ | 0..1 | decimal | Difficulty scaling factor | |
Σ | 0..1 | Money | Total additional item cost | |
Σ | 0..* | Reference(Device) | Unique Device Identifier | |
Σ | 0..* | BackboneElement | Additional items | |
Σ | 1..1 | positiveInt | Service instance | |
Σ | 1..1 | Coding | Type of product or service Exception Codes (Required) | |
Σ | 1..1 | Coding | Additional item codes USCLS Codes (Example) | |
Σ | 0..* | Coding | Program specific reason for item inclusion Example Program Reason Codes (Example) | |
Σ | 0..1 | SimpleQuantity | Count of Products or Services | |
Σ | 0..1 | Money | Fee, charge or cost per point | |
Σ | 0..1 | decimal | Price scaling factor | |
Σ | 0..1 | decimal | Difficulty scaling factor | |
Σ | 0..1 | Money | Net additional item cost | |
Σ | 0..* | Reference(Device) | Unique Device Identifier | |
Σ | 0..1 | BackboneElement | Prosthetic details | |
Σ | 0..1 | boolean | Is this the initial service | |
Σ | 0..1 | date | Initial service Date | |
Σ | 0..1 | Coding | Prosthetic Material Oral Prostho Material type Codes (Example) | |
Σ | 0..1 | Money | Total claim cost | |
Σ | 0..* | Coding | Additional supporting materials and documents Additional Material Codes (Example) | |
Σ | 0..* | BackboneElement | Only if type = oral | |
Σ | 1..1 | Coding | Tooth Code Teeth Codes (Example) | |
Σ | 0..1 | Coding | Indicates whether it was extracted or other reason Missing Tooth Reason Codes (Example) | |
Σ | 0..1 | date | Date tooth was extracted if known | |
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