openIMIS FHIR R4 Implementation Guide
1.0.0 - ci-build
openIMIS FHIR R4 Implementation Guide
1.0.0 - ci-build
openIMIS FHIR R4 Implementation Guide - Local Development build (v1.0.0). See the Directory of published versions
| Official URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/openimis-claim | Version: 1.0.0 | |||
| Active as of 2022-05-31 | Responsible: openIMIS Initiative | Computable Name: OpenIMISClaim | ||
Defines a Claim for openIMIS which maps to a Claim.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Claim
Summary
Mandatory: 19 elements (3 nested mandatory elements)
Must-Support: 2 elements
Prohibited: 42 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |
  id | 0..1 | string | Claim UUID | |
  Slices for identifier | S | 1..2 | Identifier | Business Identifier for claim Slice: Unordered, Closed by value:type.coding.code |
  identifier:All Slices | Content/Rules for all slices | |||
 type | 1..1 | CodeableConcept | Description of identifier | |
 coding | ||||
  code | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | |
 value | 1..1 | string | The value that is unique | |
 identifier:Code | S | 1..1 | Identifier | Business Identifier for claim |
 type | ||||
| coding | ||||
| code | 1..1 | code | Claim openIMIS Code Required Pattern: Code | |
 identifier:UUID | 0..1 | Identifier | Business Identifier for claim | |
| type | ||||
| coding | ||||
| code | 1..1 | code | Claim openIMIS UUID Required Pattern: UUID | |
| status | 1..1 | code | FHIR Claim Status Required Pattern: active | |
| type | ||||
| coding | 0..* | Coding | Visit type Binding: Visit Type Codes (Claim) (required) | |
| subType | 0..0 | |||
| use | 1..1 | code | Claim Type Required Pattern: claim | |
 patient | 1..1 | Reference(openIMIS Patient) | The recipient of the products and services | |
| billablePeriod | 1..1 | Period | Relevant time frame for the claim | |
| start | 1..1 | dateTime | Start date | |
| end | 0..1 | dateTime | End date | |
| created | 1..1 | dateTime | Claimed date | |
| enterer | 1..1 | Reference(openIMIS Claim Administrator Practitioner) | Author of the claim | |
| insurer | 0..0 | |||
| provider | 1..1 | Reference(openIMIS Health Facility Organization) | Health Facility | |
| priority | 1..1 | CodeableConcept | Desired processing ugency Required Pattern: At least the following | |
 coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Normal | |
| fundsReserve | 0..0 | |||
| related | 0..0 | |||
| prescription | 0..0 | |||
| originalPrescription | 0..0 | |||
| payee | 0..0 | |||
| referral | 0..0 | |||
| facility | 0..0 | |||
| careTeam | 0..0 | |||
| Slices for supportingInfo | 0..* | BackboneElement | Supporting information Slice: Unordered, Closed by value:category.coding.code | |
| supportingInfo:All Slices | Content/Rules for all slices | |||
 category | 1..1 | CodeableConcept | Classification of the supplied information Binding: Category of the supporting info (Claim) (required) | |
| code | 0..0 | |||
| timing[x] | 0..0 | |||
| value[x] | 1..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | |
| reason | 0..0 | |||
| supportingInfo:explanation | 0..1 | BackboneElement | Explanation | |
 category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
 coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: explanation | |
  value[x] | 0..1 | string | Data to be provided | |
| supportingInfo:guarantee | 0..1 | BackboneElement | Guarantee | |
| category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: guarantee | |
| value[x] | 0..1 | string | Data to be provided | |
| supportingInfo:attachment | 0..* | BackboneElement | Attachment | |
| category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachment | |
 value[x] | 0..1 | Attachment | Data to be provided | |
| diagnosis | 1..5 | BackboneElement | Diagnosis | |
| diagnosis[x] | 1..1 | CodeableConcept | Nature of illness or problem Slice: Unordered, Open by type:$this | |
| diagnosisCodeableConcept | 1..1 | CodeableConcept | Nature of illness or problem Binding: ICD 10 Level 1 diagnosis (example) | |
| type | 0..0 | |||
| onAdmission | 0..0 | |||
| packageCode | 0..0 | |||
| procedure | 0..0 | |||
| insurance | 1..1 | BackboneElement | Patient insurance information | |
| focal | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | |
| identifier | 0..0 | |||
| coverage | 1..1 | Reference(openIMIS Coverage) | Coverage | |
| businessArrangement | 0..0 | |||
| preAuthRef | 0..0 | |||
| claimResponse | 0..0 | |||
| accident | 0..0 | |||
| item | 1..* | BackboneElement | Product or service provided | |
 Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| claim-item-reference | 1..1 | Reference(openIMIS Medication | openIMIS ActivityDefinition) | Item Reference URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/claim-item-reference | |
| careTeamSequence | 0..0 | |||
| diagnosisSequence | 0..0 | |||
| procedureSequence | 0..0 | |||
| informationSequence | 0..0 | |||
| revenue | 0..0 | |||
| category | 0..1 | CodeableConcept | Category Binding: Category of the item (Claim) (required) | |
| productOrService | 1..1 | CodeableConcept | Item Code | |
| coding | 0..0 | |||
| text | 1..1 | string | Item/Service Code | |
| modifier | 0..0 | |||
| programCode | 0..0 | |||
| serviced[x] | 0..0 | |||
| location[x] | 0..0 | |||
| quantity | 1..1 | SimpleQuantity | Count of products or services | |
| value | 1..1 | decimal | Numerical value (with implicit precision) | |
| unit | 0..0 | |||
| system | 0..0 | |||
| code | 0..0 | |||
| unitPrice | 1..1 | Money | Fee, charge or cost per item | |
| value | 1..1 | decimal | Numerical value (with implicit precision) | |
| factor | 0..0 | |||
| net | 0..0 | |||
| udi | 0..0 | |||
| bodySite | 0..0 | |||
| subSite | 0..0 | |||
| encounter | 0..0 | |||
| detail | 0..0 | |||
| total | 1..1 | Money | Total claim cost | |
| value | 1..1 | decimal | Numerical value (with implicit precision) | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||
| id | Σ | 0..1 | string | Claim UUID | ||||
| 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): 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 | ||||
| Slices for identifier | S | 1..2 | Identifier | Business Identifier for claim Slice: Unordered, Closed by value:type.coding.code | ||||
| identifier:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 0..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| identifier:Code | S | 1..1 | Identifier | Business Identifier for claim | ||||
 id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 0..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Claim openIMIS Code Required Pattern: Code | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| identifier:UUID | 0..1 | Identifier | Business Identifier for claim | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 0..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Claim openIMIS UUID Required Pattern: UUID | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| status | ?!Σ | 1..1 | code | FHIR Claim Status Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active | ||||
| type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 0..* | Coding | Visit type Binding: Visit Type Codes (Claim) (required) | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| use | Σ | 1..1 | code | Claim Type Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: claim | ||||
| patient | Σ | 1..1 | Reference(openIMIS Patient) | The recipient of the products and services | ||||
| billablePeriod | Σ | 1..1 | Period | Relevant time frame for the claim | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start | ΣI | 1..1 | dateTime | Start date | ||||
| end | ΣI | 0..1 | dateTime | End date | ||||
| created | Σ | 1..1 | dateTime | Claimed date | ||||
| enterer | 1..1 | Reference(openIMIS Claim Administrator Practitioner) | Author of the claim | |||||
| provider | Σ | 1..1 | Reference(openIMIS Health Facility Organization) | Health Facility | ||||
| priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. Required Pattern: At least the following | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal | |||||
| display | 1..1 | string | Representation defined by the system Fixed Value: Normal | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| Slices for supportingInfo | 0..* | BackboneElement | Supporting information Slice: Unordered, Closed by value:category.coding.code | |||||
| supportingInfo:All Slices | Content/Rules for all slices | |||||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: Category of the supporting info (Claim) (required) | |||||
 value[x] | 1..1 | Data to be provided | ||||||
| valueBoolean | boolean | |||||||
| valueString | string | |||||||
| valueQuantity | Quantity | |||||||
| valueAttachment | Attachment | |||||||
| valueReference | Reference(Resource) | |||||||
| supportingInfo:explanation | 0..1 | BackboneElement | Explanation | |||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: explanation | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| timing[x] | 0..1 | When it occurred | ||||||
| timingDate | date | |||||||
| timingPeriod | Period | |||||||
| value[x] | 0..1 | string | Data to be provided | |||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:guarantee | 0..1 | BackboneElement | Guarantee | |||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: guarantee | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| timing[x] | 0..1 | When it occurred | ||||||
| timingDate | date | |||||||
| timingPeriod | Period | |||||||
| value[x] | 0..1 | string | Data to be provided | |||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:attachment | 0..* | BackboneElement | Attachment | |||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachment | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| timing[x] | 0..1 | When it occurred | ||||||
| timingDate | date | |||||||
| timingPeriod | Period | |||||||
| value[x] | 0..1 | Attachment | Data to be provided | |||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| diagnosis | 1..5 | BackboneElement | Diagnosis | |||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | |||||
| Slices for diagnosis[x] | 1..1 | CodeableConcept | Nature of illness or problem Slice: Unordered, Closed by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | |||||
| diagnosis[x]:diagnosisCodeableConcept | 1..1 | CodeableConcept | Nature of illness or problem Binding: ICD 10 Level 1 diagnosis (example) | |||||
| insurance | Σ | 1..1 | BackboneElement | Patient insurance information | ||||
| 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 | ||||
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier | ||||
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | ||||
| coverage | Σ | 1..1 | Reference(openIMIS Coverage) | Coverage | ||||
| item | 1..* | BackboneElement | Product or service provided | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| claim-item-reference | 1..1 | Reference(openIMIS Medication | openIMIS ActivityDefinition) | Item Reference URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/claim-item-reference | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Item instance identifier | |||||
| category | 0..1 | CodeableConcept | Category Binding: Category of the item (Claim) (required) | |||||
| productOrService | 1..1 | CodeableConcept | Item Code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| text | Σ | 1..1 | string | Item/Service Code | ||||
| quantity | 1..1 | SimpleQuantity | Count of products or services | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | Σ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
| unitPrice | 1..1 | Money | Fee, charge or cost per item | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | Σ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
| currency | Σ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. | ||||
| total | 1..1 | Money | Total claim cost | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | Σ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
| currency | Σ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. | ||||
| Documentation for this format | ||||||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |
| Slices for identifier | 1..2 | Identifier | Business Identifier for claim Slice: Unordered, Closed by value:type.coding.code | |
| identifier:Code | 1..1 | Identifier | Business Identifier for claim | |
| Documentation for this format | ||||
This structure is derived from Claim
Summary
Mandatory: 19 elements (3 nested mandatory elements)
Must-Support: 2 elements
Prohibited: 42 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |
| id | 0..1 | string | Claim UUID | |
| Slices for identifier | S | 1..2 | Identifier | Business Identifier for claim Slice: Unordered, Closed by value:type.coding.code |
| identifier:All Slices | Content/Rules for all slices | |||
| type | 1..1 | CodeableConcept | Description of identifier | |
| coding | ||||
| code | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | |
| value | 1..1 | string | The value that is unique | |
| identifier:Code | S | 1..1 | Identifier | Business Identifier for claim |
| type | ||||
| coding | ||||
| code | 1..1 | code | Claim openIMIS Code Required Pattern: Code | |
| identifier:UUID | 0..1 | Identifier | Business Identifier for claim | |
| type | ||||
| coding | ||||
| code | 1..1 | code | Claim openIMIS UUID Required Pattern: UUID | |
| status | 1..1 | code | FHIR Claim Status Required Pattern: active | |
| type | ||||
| coding | 0..* | Coding | Visit type Binding: Visit Type Codes (Claim) (required) | |
| subType | 0..0 | |||
| use | 1..1 | code | Claim Type Required Pattern: claim | |
| patient | 1..1 | Reference(openIMIS Patient) | The recipient of the products and services | |
| billablePeriod | 1..1 | Period | Relevant time frame for the claim | |
| start | 1..1 | dateTime | Start date | |
| end | 0..1 | dateTime | End date | |
| created | 1..1 | dateTime | Claimed date | |
| enterer | 1..1 | Reference(openIMIS Claim Administrator Practitioner) | Author of the claim | |
| insurer | 0..0 | |||
| provider | 1..1 | Reference(openIMIS Health Facility Organization) | Health Facility | |
| priority | 1..1 | CodeableConcept | Desired processing ugency Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Normal | |
| fundsReserve | 0..0 | |||
| related | 0..0 | |||
| prescription | 0..0 | |||
| originalPrescription | 0..0 | |||
| payee | 0..0 | |||
| referral | 0..0 | |||
| facility | 0..0 | |||
| careTeam | 0..0 | |||
| Slices for supportingInfo | 0..* | BackboneElement | Supporting information Slice: Unordered, Closed by value:category.coding.code | |
| supportingInfo:All Slices | Content/Rules for all slices | |||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: Category of the supporting info (Claim) (required) | |
| code | 0..0 | |||
| timing[x] | 0..0 | |||
| value[x] | 1..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | |
| reason | 0..0 | |||
| supportingInfo:explanation | 0..1 | BackboneElement | Explanation | |
| category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: explanation | |
| value[x] | 0..1 | string | Data to be provided | |
| supportingInfo:guarantee | 0..1 | BackboneElement | Guarantee | |
| category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: guarantee | |
| value[x] | 0..1 | string | Data to be provided | |
| supportingInfo:attachment | 0..* | BackboneElement | Attachment | |
| category | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachment | |
| value[x] | 0..1 | Attachment | Data to be provided | |
| diagnosis | 1..5 | BackboneElement | Diagnosis | |
| diagnosis[x] | 1..1 | CodeableConcept | Nature of illness or problem Slice: Unordered, Open by type:$this | |
| diagnosisCodeableConcept | 1..1 | CodeableConcept | Nature of illness or problem Binding: ICD 10 Level 1 diagnosis (example) | |
| type | 0..0 | |||
| onAdmission | 0..0 | |||
| packageCode | 0..0 | |||
| procedure | 0..0 | |||
| insurance | 1..1 | BackboneElement | Patient insurance information | |
| focal | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | |
| identifier | 0..0 | |||
| coverage | 1..1 | Reference(openIMIS Coverage) | Coverage | |
| businessArrangement | 0..0 | |||
| preAuthRef | 0..0 | |||
| claimResponse | 0..0 | |||
| accident | 0..0 | |||
| item | 1..* | BackboneElement | Product or service provided | |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| claim-item-reference | 1..1 | Reference(openIMIS Medication | openIMIS ActivityDefinition) | Item Reference URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/claim-item-reference | |
| careTeamSequence | 0..0 | |||
| diagnosisSequence | 0..0 | |||
| procedureSequence | 0..0 | |||
| informationSequence | 0..0 | |||
| revenue | 0..0 | |||
| category | 0..1 | CodeableConcept | Category Binding: Category of the item (Claim) (required) | |
| productOrService | 1..1 | CodeableConcept | Item Code | |
| coding | 0..0 | |||
| text | 1..1 | string | Item/Service Code | |
| modifier | 0..0 | |||
| programCode | 0..0 | |||
| serviced[x] | 0..0 | |||
| location[x] | 0..0 | |||
| quantity | 1..1 | SimpleQuantity | Count of products or services | |
| value | 1..1 | decimal | Numerical value (with implicit precision) | |
| unit | 0..0 | |||
| system | 0..0 | |||
| code | 0..0 | |||
| unitPrice | 1..1 | Money | Fee, charge or cost per item | |
| value | 1..1 | decimal | Numerical value (with implicit precision) | |
| factor | 0..0 | |||
| net | 0..0 | |||
| udi | 0..0 | |||
| bodySite | 0..0 | |||
| subSite | 0..0 | |||
| encounter | 0..0 | |||
| detail | 0..0 | |||
| total | 1..1 | Money | Total claim cost | |
| value | 1..1 | decimal | Numerical value (with implicit precision) | |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| Claim | 0..* | Claim | Claim, Pre-determination or Pre-authorization | |||||
| id | Σ | 0..1 | string | Claim UUID | ||||
| 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): 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 | ||||
| Slices for identifier | S | 1..2 | Identifier | Business Identifier for claim Slice: Unordered, Closed by value:type.coding.code | ||||
| identifier:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 0..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 0..1 | code | Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required) | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| identifier:Code | S | 1..1 | Identifier | Business Identifier for claim | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 0..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Claim openIMIS Code Required Pattern: Code | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| identifier:UUID | 0..1 | Identifier | Business Identifier for claim | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 0..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Claim openIMIS UUID Required Pattern: UUID | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| status | ?!Σ | 1..1 | code | FHIR Claim Status Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active | ||||
| type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 0..* | Coding | Visit type Binding: Visit Type Codes (Claim) (required) | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| use | Σ | 1..1 | code | Claim Type Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: claim | ||||
| patient | Σ | 1..1 | Reference(openIMIS Patient) | The recipient of the products and services | ||||
| billablePeriod | Σ | 1..1 | Period | Relevant time frame for the claim | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start | ΣI | 1..1 | dateTime | Start date | ||||
| end | ΣI | 0..1 | dateTime | End date | ||||
| created | Σ | 1..1 | dateTime | Claimed date | ||||
| enterer | 1..1 | Reference(openIMIS Claim Administrator Practitioner) | Author of the claim | |||||
| provider | Σ | 1..1 | Reference(openIMIS Health Facility Organization) | Health Facility | ||||
| priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. Required Pattern: At least the following | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: normal | |||||
| display | 1..1 | string | Representation defined by the system Fixed Value: Normal | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| Slices for supportingInfo | 0..* | BackboneElement | Supporting information Slice: Unordered, Closed by value:category.coding.code | |||||
| supportingInfo:All Slices | Content/Rules for all slices | |||||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: Category of the supporting info (Claim) (required) | |||||
| value[x] | 1..1 | Data to be provided | ||||||
| valueBoolean | boolean | |||||||
| valueString | string | |||||||
| valueQuantity | Quantity | |||||||
| valueAttachment | Attachment | |||||||
| valueReference | Reference(Resource) | |||||||
| supportingInfo:explanation | 0..1 | BackboneElement | Explanation | |||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: explanation | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| timing[x] | 0..1 | When it occurred | ||||||
| timingDate | date | |||||||
| timingPeriod | Period | |||||||
| value[x] | 0..1 | string | Data to be provided | |||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:guarantee | 0..1 | BackboneElement | Guarantee | |||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: guarantee | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| timing[x] | 0..1 | When it occurred | ||||||
| timingDate | date | |||||||
| timingPeriod | Period | |||||||
| value[x] | 0..1 | string | Data to be provided | |||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| supportingInfo:attachment | 0..* | BackboneElement | Attachment | |||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: https://openimis.github.io/openimis_fhir_r4_ig/CodeSystem/claim-supporting-info-category | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attachment | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| timing[x] | 0..1 | When it occurred | ||||||
| timingDate | date | |||||||
| timingPeriod | Period | |||||||
| value[x] | 0..1 | Attachment | Data to be provided | |||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| diagnosis | 1..5 | BackboneElement | Diagnosis | |||||
| 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 | ||||
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | |||||
| Slices for diagnosis[x] | 1..1 | CodeableConcept | Nature of illness or problem Slice: Unordered, Closed by type:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | |||||
| diagnosis[x]:diagnosisCodeableConcept | 1..1 | CodeableConcept | Nature of illness or problem Binding: ICD 10 Level 1 diagnosis (example) | |||||
| insurance | Σ | 1..1 | BackboneElement | Patient insurance information | ||||
| 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 | ||||
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier | ||||
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Required Pattern: true | ||||
| coverage | Σ | 1..1 | Reference(openIMIS Coverage) | Coverage | ||||
| item | 1..* | BackboneElement | Product or service provided | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| claim-item-reference | 1..1 | Reference(openIMIS Medication | openIMIS ActivityDefinition) | Item Reference URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/claim-item-reference | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Item instance identifier | |||||
| category | 0..1 | CodeableConcept | Category Binding: Category of the item (Claim) (required) | |||||
| productOrService | 1..1 | CodeableConcept | Item Code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| text | Σ | 1..1 | string | Item/Service Code | ||||
| quantity | 1..1 | SimpleQuantity | Count of products or services | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | Σ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
| unitPrice | 1..1 | Money | Fee, charge or cost per item | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | Σ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
| currency | Σ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. | ||||
| total | 1..1 | Money | Total claim cost | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | Σ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
| currency | Σ | 0..1 | code | ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217. | ||||
| Documentation for this format | ||||||||
Other representations of profile: CSV, Excel, Schematron
| Path | Conformance | ValueSet / Code |
| Claim.language | preferred | CommonLanguages Max Binding: AllLanguages |
| Claim.identifier.use | required | IdentifierUse |
| Claim.identifier.type | extensible | Identifier Type Codes |
| Claim.identifier.type.coding.code | required | OpenIMISIdentifierVS |
| Claim.identifier:Code.use | required | IdentifierUse |
| Claim.identifier:Code.type | extensible | Identifier Type Codes |
| Claim.identifier:UUID.use | required | IdentifierUse |
| Claim.identifier:UUID.type | extensible | Identifier Type Codes |
| Claim.status | required | Pattern: active |
| Claim.type | extensible | ClaimTypeCodes |
| Claim.type.coding | required | ClaimVisitTypeVS |
| Claim.use | required | Pattern: claim |
| Claim.priority | example | Pattern: normal("Normal") |
| Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodes |
| Claim.payee.type | example | Claim Payee Type Codes |
| Claim.careTeam.role | example | ClaimCareTeamRoleCodes |
| Claim.careTeam.qualification | example | ExampleProviderQualificationCodes |
| Claim.supportingInfo.category | required | ClaimSupportingInfoCategoryVS |
| Claim.supportingInfo:explanation.category | example | Pattern: explanation |
| Claim.supportingInfo:explanation.code | example | ExceptionCodes |
| Claim.supportingInfo:explanation.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:guarantee.category | example | Pattern: guarantee |
| Claim.supportingInfo:guarantee.code | example | ExceptionCodes |
| Claim.supportingInfo:guarantee.reason | example | MissingToothReasonCodes |
| Claim.supportingInfo:attachment.category | example | Pattern: attachment |
| Claim.supportingInfo:attachment.code | example | ExceptionCodes |
| Claim.supportingInfo:attachment.reason | example | MissingToothReasonCodes |
| Claim.diagnosis.diagnosis[x] | example | ICD-10Codes |
| Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept | example | DiagnosisICD10Level1VS |
| Claim.procedure.type | example | ExampleProcedureTypeCodes |
| Claim.procedure.procedure[x] | example | ICD-10ProcedureCodes |
| Claim.accident.type | extensible | ActIncidentCode |
| Claim.item.category | required | ClaimItemCategoryVS |
| Claim.item.productOrService | example | USCLSCodes |
| Claim.item.unitPrice.currency | required | Currencies |
| 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 |
| Claim.total.currency | required | Currencies |
| Id | Grade | Path | Details | Requirements |
| dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | 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 | error | 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 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | Best Practice | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | Claim.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.identifier.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.type.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.identifier.type.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier.type.coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.type.coding.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.identifier.type.coding.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier.type.coding.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.type.coding.version | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.type.coding.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.type.coding.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.type.coding.userSelected | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.type.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.period | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier.assigner | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.identifier:Code.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier:Code.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.type.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.identifier:Code.type.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier:Code.type.coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.type.coding.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.identifier:Code.type.coding.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier:Code.type.coding.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.type.coding.version | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.type.coding.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.type.coding.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.type.coding.userSelected | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.type.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.period | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:Code.assigner | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.identifier:UUID.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier:UUID.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.type.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.identifier:UUID.type.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier:UUID.type.coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.type.coding.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.identifier:UUID.type.coding.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.identifier:UUID.type.coding.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.type.coding.version | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.type.coding.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.type.coding.display | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.type.coding.userSelected | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.type.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.system | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.period | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.identifier:UUID.assigner | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.status | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.type.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.type.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.type.coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.type.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.use | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.patient | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.billablePeriod | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.billablePeriod.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.billablePeriod.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.billablePeriod.start | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.billablePeriod.end | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.created | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.enterer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.priority | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.related.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.related.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.related.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.related.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.related.claim | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.related.relationship | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.related.reference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.payee.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.payee.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.payee.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.payee.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.payee.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.payee.party | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.careTeam.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.careTeam.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.careTeam.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.careTeam.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.careTeam.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.careTeam.provider | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.careTeam.responsible | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.careTeam.role | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.careTeam.qualification | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.supportingInfo.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.supportingInfo.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.supportingInfo.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.supportingInfo.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:explanation | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:explanation.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.supportingInfo:explanation.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.supportingInfo:explanation.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.supportingInfo:explanation.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.supportingInfo:explanation.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:explanation.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:explanation.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:explanation.timing[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:explanation.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:explanation.reason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:guarantee | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:guarantee.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.supportingInfo:guarantee.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.supportingInfo:guarantee.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.supportingInfo:guarantee.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.supportingInfo:guarantee.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:guarantee.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:guarantee.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:guarantee.timing[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:guarantee.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:guarantee.reason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:attachment | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:attachment.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.supportingInfo:attachment.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.supportingInfo:attachment.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.supportingInfo:attachment.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.supportingInfo:attachment.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:attachment.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:attachment.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:attachment.timing[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:attachment.value[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.supportingInfo:attachment.reason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.diagnosis | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.diagnosis.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.diagnosis.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.diagnosis.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.diagnosis.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.diagnosis.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.diagnosis.diagnosis[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.procedure.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.procedure.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.procedure.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.procedure.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.procedure.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.procedure.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.procedure.date | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.procedure.procedure[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.procedure.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.insurance | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.insurance.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.insurance.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.insurance.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.insurance.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.insurance.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.insurance.focal | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.insurance.coverage | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.accident.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.accident.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.accident.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.accident.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.accident.date | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.accident.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.accident.location[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.extension:itemReference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.extension:itemReference | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.productOrService.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.productOrService.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.productOrService.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.quantity.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.quantity.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.quantity.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.unitPrice | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.unitPrice.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.unitPrice.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.unitPrice.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.unitPrice.currency | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.detail.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.detail.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.detail.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.detail.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.revenue | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.programCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.unitPrice | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.factor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.net | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.detail.subDetail.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.detail.subDetail.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.item.detail.subDetail.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.item.detail.subDetail.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.revenue | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.productOrService | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.modifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.programCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.unitPrice | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.factor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.net | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.item.detail.subDetail.udi | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.total | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.total.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | Claim.total.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | error | Claim.total.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ele-1 | error | Claim.total.currency | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |