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 |