Guide d'implémentation du GT Standards et Interopérabilité pour les EDS
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Guide d'implémentation du GT Standards et Interopérabilité pour les EDS - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: EDSClaimRSS - Detailed Descriptions

Draft as of 2024-11-23

Definitions for the EDSClaimRSS resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Claim
2. Claim.billablePeriod
Must Supporttrue
4. Claim.billablePeriod.start
Shortdate d'entrée dans la première unité médicale visitée
6. Claim.billablePeriod.end
Shortdate de sortie de la dernière unité médicale visitée
8. Claim.supportingInfo
ShortsupportingInfo
Control2..?
SlicingThis element introduces a set of slices on Claim.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ code.coding.code
  • value @ code.coding.system
  • 10. Claim.supportingInfo:ModeIn
    Slice NameModeIn
    Control1..1
    Must Supporttrue
    12. Claim.supportingInfo:ModeIn.category
    Fixed Value{
      "coding" : [{
        "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO",
        "code" : "RUM"
      }]
    }
    14. Claim.supportingInfo:ModeIn.code
    16. Claim.supportingInfo:ModeIn.code.coding
    Control1..?
    SlicingThis element introduces a set of slices on Claim.supportingInfo.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ code
    • value @ system
    • 18. Claim.supportingInfo:ModeIn.code.coding:ModeInCode
      Slice NameModeInCode
      Control1..1
      Must Supporttrue
      20. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.system
      Control1..?
      Fixed Valuehttps://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
      22. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.code
      Control1..?
      Fixed Value0
      24. Claim.supportingInfo:ModeIn.value[x]
      Shortvaleur du mode d'entrée
      Typestring
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      26. Claim.supportingInfo:ModeOut
      Slice NameModeOut
      Control1..1
      Must Supporttrue
      28. Claim.supportingInfo:ModeOut.category
      Fixed Value{
        "coding" : [{
          "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO",
          "code" : "RUM"
        }]
      }
      30. Claim.supportingInfo:ModeOut.code
      32. Claim.supportingInfo:ModeOut.code.coding
      Control1..?
      SlicingThis element introduces a set of slices on Claim.supportingInfo.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ code
      • value @ system
      • 34. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode
        Slice NameModeOutCode
        Control1..1
        Must Supporttrue
        36. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.system
        Control1..?
        Fixed Valuehttps://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
        38. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.code
        Control1..?
        Fixed Value1
        40. Claim.supportingInfo:ModeOut.value[x]
        Shortvaleur du mode de sortie
        Typestring
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        42. Claim.diagnosis
        Control1..?
        Must Supporttrue
        SlicingThis element introduces a set of slices on Claim.diagnosis. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ type
        • 44. Claim.diagnosis:dp
          Slice Namedp
          Control1..1
          Must Supporttrue
          46. Claim.diagnosis:dp.diagnosis[x]
          BindingThe codes SHALL be taken from Liste des diagnostiques CIM-10 acceptable en DP pour les PMSI MCO et HAD
          (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDP)
          TypeCodeableConcept
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          48. Claim.diagnosis:dp.type
          Control1..?
          Fixed Value{
            "coding" : [{
              "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
              "code" : "DP"
            }]
          }
          50. Claim.diagnosis:dr
          Slice Namedr
          Control0..1
          Must Supporttrue
          52. Claim.diagnosis:dr.diagnosis[x]
          BindingThe codes SHALL be taken from Liste des diagnostiques CIM-10 acceptable en DR pour les PMSI MCO et HAD
          (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDR)
          TypeCodeableConcept
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          54. Claim.diagnosis:dr.type
          Control1..?
          Fixed Value{
            "coding" : [{
              "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
              "code" : "DR"
            }]
          }
          56. Claim.diagnosis:da
          Slice Nameda
          Control0..*
          Must Supporttrue
          58. Claim.diagnosis:da.diagnosis[x]
          BindingThe codes SHALL be taken from Liste des diagnostiques CIM-10 acceptable en DA pour les PMSI MCO et HAD
          (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDA)
          TypeCodeableConcept
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          60. Claim.diagnosis:da.type
          Control1..?
          Fixed Value{
            "coding" : [{
              "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
              "code" : "DA"
            }]
          }
          62. Claim.diagnosis:dad
          Slice Namedad
          Control0..*
          Must Supporttrue
          64. Claim.diagnosis:dad.diagnosis[x]
          BindingThe codes SHALL be taken from Liste des diagnostiques CIM-10 pour le PMSI
          (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSI)
          TypeCodeableConcept
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          66. Claim.diagnosis:dad.type
          Control1..?
          Fixed Value{
            "coding" : [{
              "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
              "code" : "DAD"
            }]
          }
          68. Claim.procedure
          Must Supporttrue
          70. Claim.procedure.procedure[x]
          BindingThe codes SHALL be taken from Actes CCAM pour le PMSI
          (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CCAM)
          TypeCodeableConcept, Reference(Procedure)
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]

          Guidance on how to interpret the contents of this table can be found here

          0. Claim
          Definition

          A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

          ShortClaim, Pre-determination or Pre-authorization
          Comments

          The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.

          Control0..*
          Is Modifierfalse
          Summaryfalse
          Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
          Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
          dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
          dom-6: A resource should have narrative for robust management (text.`div`.exists())
          2. Claim.implicitRules
          Definition

          A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

          ShortA set of rules under which this content was created
          Comments

          Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

          Control0..1
          Typeuri
          Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          4. Claim.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Summaryfalse
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          6. Claim.status
          Definition

          The status of the resource instance.

          Shortactive | cancelled | draft | entered-in-error
          Comments

          This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

          Control1..1
          BindingThe codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1
          (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

          A code specifying the state of the resource instance.

          Typecode
          Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          8. Claim.type
          Definition

          The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

          ShortChamp du PMSI concerné.Category or discipline
          Comments

          The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.

          Control1..1
          BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from ValueSet des type fr des claimshttp://hl7.org/fhir/ValueSet/claim-type
          (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/FrClaimType)
          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          Claim type determine the general sets of business rules applied for information requirements and adjudication.

          Pattern Value{
            "coding" : [{
              "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimType",
              "code" : "PMSIMCO"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          10. Claim.use
          Definition

          A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

          Shortclaim | preauthorization | predetermination
          Control1..1
          BindingThe codes SHALL be taken from Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1
          (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

          The purpose of the Claim: predetermination, preauthorization, claim.

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          This element is required to understand the nature of the request for adjudication.

          Pattern Valueclaim
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          12. Claim.patient
          Definition

          The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

          ShortThe recipient of the products and services
          Control1..1
          TypeReference(Patient, Patient)
          Is Modifierfalse
          Summarytrue
          Requirements

          The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          14. Claim.billablePeriod
          Definition

          The period for which charges are being submitted.

          ShortRelevant time frame for the claim
          Comments

          Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.

          Control0..1
          TypePeriod
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          16. Claim.billablePeriod.start
          Definition

          The start of the period. The boundary is inclusive.

          Shortdate d'entrée dans la première unité médicale visitéeStarting time with inclusive boundary
          Comments

          If the low element is missing, the meaning is that the low boundary is not known.

          Control0..1
          This element is affected by the following invariants: per-1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          18. Claim.billablePeriod.end
          Definition

          The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

          Shortdate de sortie de la dernière unité médicale visitéeEnd time with inclusive boundary, if not ongoing
          Comments

          The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

          Control0..1
          This element is affected by the following invariants: per-1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          20. Claim.created
          Definition

          The date this resource was created.

          ShortResource creation date
          Comments

          This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

          Control1..1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to record a timestamp for use by both the recipient and the issuer.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          22. Claim.provider
          Definition

          The provider which is responsible for the claim, predetermination or preauthorization.

          ShortEntité juridique émettriceParty responsible for the claim
          Comments

          Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

          Control1..1
          TypeReference(Practitioner, PractitionerRole, Organization)
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          24. Claim.priority
          Definition

          The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

          ShortDesired processing ugency
          Comments

          If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.

          Control1..1
          BindingFor example codes, see ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priority
          (example to http://hl7.org/fhir/ValueSet/process-priority)

          The timeliness with which processing is required: stat, normal, deferred.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
              "code" : "normal"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          26. Claim.supportingInfo
          Definition

          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

          ShortsupportingInfoSupporting information
          Comments

          Often there are multiple jurisdiction specific valuesets which are required.

          Control20..*
          TypeBackboneElement
          Is Modifierfalse
          Summaryfalse
          Requirements

          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

          Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Claim.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ code.coding.code
          • value @ code.coding.system
          • 28. Claim.supportingInfo.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            30. Claim.supportingInfo.sequence
            Definition

            A number to uniquely identify supporting information entries.

            ShortInformation instance identifier
            Control1..1
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Requirements

            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. Claim.supportingInfo.category
            Definition

            The general class of the information supplied: information; exception; accident, employment; onset, etc.

            ShortClassification of the supplied information
            Comments

            This may contain a category for the local bill type codes.

            Control1..1
            BindingFor example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory
            (example to http://hl7.org/fhir/ValueSet/claim-informationcategory)

            The valuset used for additional information category codes.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Requirements

            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. Claim.supportingInfo:ModeIn
            Slice NameModeIn
            Definition

            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

            ShortSupporting information
            Comments

            Often there are multiple jurisdiction specific valuesets which are required.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

            Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. Claim.supportingInfo:ModeIn.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            38. Claim.supportingInfo:ModeIn.sequence
            Definition

            A number to uniquely identify supporting information entries.

            ShortInformation instance identifier
            Control1..1
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Requirements

            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. Claim.supportingInfo:ModeIn.category
            Definition

            The general class of the information supplied: information; exception; accident, employment; onset, etc.

            ShortClassification of the supplied information
            Comments

            This may contain a category for the local bill type codes.

            Control1..1
            BindingFor example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory
            (example to http://hl7.org/fhir/ValueSet/claim-informationcategory)

            The valuset used for additional information category codes.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Requirements

            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

            Fixed Value{
              "coding" : [{
                "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO",
                "code" : "RUM"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. Claim.supportingInfo:ModeIn.code
            Definition

            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

            ShortType of information
            Control0..1
            BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
            (example to http://hl7.org/fhir/ValueSet/claim-exception)

            The valuset used for additional information codes.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Requirements

            Required to identify the kind of additional information.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. Claim.supportingInfo:ModeIn.code.coding
            Definition

            A reference to a code defined by a terminology system.

            ShortCode defined by a terminology system
            Comments

            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

            Control10..*
            TypeCoding
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows for alternative encodings within a code system, and translations to other code systems.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Claim.supportingInfo.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ code
            • value @ system
            • 46. Claim.supportingInfo:ModeIn.code.coding:ModeInCode
              Slice NameModeInCode
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

              Control10..1*
              TypeCoding
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Allows for alternative encodings within a code system, and translations to other code systems.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              48. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.system
              Definition

              The identification of the code system that defines the meaning of the symbol in the code.

              ShortIdentity of the terminology system
              Comments

              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

              Control10..1
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to be unambiguous about the source of the definition of the symbol.

              Fixed Valuehttps://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              50. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.code
              Definition

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

              ShortSymbol in syntax defined by the system
              Control10..1
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to refer to a particular code in the system.

              Fixed Value0
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              52. Claim.supportingInfo:ModeIn.value[x]
              Definition

              Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

              Shortvaleur du mode d'entréeData to be provided
              Comments

              Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

              Control0..1
              Typestring, boolean, Reference(Resource), Quantity, Attachment
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              To convey the data content to be provided when the information is more than a simple code or period.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              54. Claim.supportingInfo:ModeOut
              Slice NameModeOut
              Definition

              Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

              ShortSupporting information
              Comments

              Often there are multiple jurisdiction specific valuesets which are required.

              Control10..1*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

              Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              56. Claim.supportingInfo:ModeOut.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              58. Claim.supportingInfo:ModeOut.sequence
              Definition

              A number to uniquely identify supporting information entries.

              ShortInformation instance identifier
              Control1..1
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

              Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              60. Claim.supportingInfo:ModeOut.category
              Definition

              The general class of the information supplied: information; exception; accident, employment; onset, etc.

              ShortClassification of the supplied information
              Comments

              This may contain a category for the local bill type codes.

              Control1..1
              BindingFor example codes, see ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategory
              (example to http://hl7.org/fhir/ValueSet/claim-informationcategory)

              The valuset used for additional information category codes.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

              Fixed Value{
                "coding" : [{
                  "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO",
                  "code" : "RUM"
                }]
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              62. Claim.supportingInfo:ModeOut.code
              Definition

              System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

              ShortType of information
              Control0..1
              BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
              (example to http://hl7.org/fhir/ValueSet/claim-exception)

              The valuset used for additional information codes.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to identify the kind of additional information.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. Claim.supportingInfo:ModeOut.code.coding
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

              Control10..*
              TypeCoding
              Is Modifierfalse
              Summarytrue
              Requirements

              Allows for alternative encodings within a code system, and translations to other code systems.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Claim.supportingInfo.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ code
              • value @ system
              • 66. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode
                Slice NameModeOutCode
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                Control10..1*
                TypeCoding
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Allows for alternative encodings within a code system, and translations to other code systems.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                68. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.system
                Definition

                The identification of the code system that defines the meaning of the symbol in the code.

                ShortIdentity of the terminology system
                Comments

                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                Control10..1
                Typeuri
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Need to be unambiguous about the source of the definition of the symbol.

                Fixed Valuehttps://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                70. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.code
                Definition

                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                ShortSymbol in syntax defined by the system
                Control10..1
                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Need to refer to a particular code in the system.

                Fixed Value1
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                72. Claim.supportingInfo:ModeOut.value[x]
                Definition

                Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                Shortvaleur du mode de sortieData to be provided
                Comments

                Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

                Control0..1
                Typestring, boolean, Reference(Resource), Quantity, Attachment
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summaryfalse
                Requirements

                To convey the data content to be provided when the information is more than a simple code or period.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                74. Claim.diagnosis
                Definition

                Information about diagnoses relevant to the claim items.

                ShortPertinent diagnosis information
                Control10..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Required for the adjudication by provided context for the services and product listed.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Claim.diagnosis. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ type
                • 76. Claim.diagnosis.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  78. Claim.diagnosis.sequence
                  Definition

                  A number to uniquely identify diagnosis entries.

                  ShortDiagnosis instance identifier
                  Comments

                  Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  80. Claim.diagnosis.diagnosis[x]
                  Definition

                  The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                  ShortNature of illness or problem
                  Control1..1
                  BindingFor example codes, see ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10
                  (example to http://hl7.org/fhir/ValueSet/icd-10)

                  Example ICD10 Diagnostic codes.

                  TypeChoice of: CodeableConcept, Reference(Condition)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Provides health context for the evaluation of the products and/or services.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  82. Claim.diagnosis:dp
                  Slice Namedp
                  Definition

                  Information about diagnoses relevant to the claim items.

                  ShortPertinent diagnosis information
                  Control10..1*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Required for the adjudication by provided context for the services and product listed.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  84. Claim.diagnosis:dp.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  86. Claim.diagnosis:dp.sequence
                  Definition

                  A number to uniquely identify diagnosis entries.

                  ShortDiagnosis instance identifier
                  Comments

                  Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  88. Claim.diagnosis:dp.diagnosis[x]
                  Definition

                  The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                  ShortNature of illness or problem
                  Control1..1
                  BindingThe codes SHALL be taken from For example codes, see Liste des diagnostiques CIM-10 acceptable en DP pour les PMSI MCO et HADhttp://hl7.org/fhir/ValueSet/icd-10
                  (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDP)
                  TypeCodeableConcept, Reference(Condition)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Provides health context for the evaluation of the products and/or services.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  90. Claim.diagnosis:dp.type
                  Definition

                  When the condition was observed or the relative ranking.

                  ShortTiming or nature of the diagnosis
                  Comments

                  For example: admitting, primary, secondary, discharge.

                  Control10..*
                  BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                  (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                  The type of the diagnosis: admitting, principal, discharge.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Often required to capture a particular diagnosis, for example: primary or discharge.

                  Fixed Value{
                    "coding" : [{
                      "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
                      "code" : "DP"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  92. Claim.diagnosis:dr
                  Slice Namedr
                  Definition

                  Information about diagnoses relevant to the claim items.

                  ShortPertinent diagnosis information
                  Control0..1*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Required for the adjudication by provided context for the services and product listed.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  94. Claim.diagnosis:dr.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  96. Claim.diagnosis:dr.sequence
                  Definition

                  A number to uniquely identify diagnosis entries.

                  ShortDiagnosis instance identifier
                  Comments

                  Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  98. Claim.diagnosis:dr.diagnosis[x]
                  Definition

                  The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                  ShortNature of illness or problem
                  Control1..1
                  BindingThe codes SHALL be taken from For example codes, see Liste des diagnostiques CIM-10 acceptable en DR pour les PMSI MCO et HADhttp://hl7.org/fhir/ValueSet/icd-10
                  (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDR)
                  TypeCodeableConcept, Reference(Condition)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Provides health context for the evaluation of the products and/or services.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  100. Claim.diagnosis:dr.type
                  Definition

                  When the condition was observed or the relative ranking.

                  ShortTiming or nature of the diagnosis
                  Comments

                  For example: admitting, primary, secondary, discharge.

                  Control10..*
                  BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                  (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                  The type of the diagnosis: admitting, principal, discharge.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Often required to capture a particular diagnosis, for example: primary or discharge.

                  Fixed Value{
                    "coding" : [{
                      "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
                      "code" : "DR"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  102. Claim.diagnosis:da
                  Slice Nameda
                  Definition

                  Information about diagnoses relevant to the claim items.

                  ShortPertinent diagnosis information
                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Required for the adjudication by provided context for the services and product listed.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  104. Claim.diagnosis:da.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  106. Claim.diagnosis:da.sequence
                  Definition

                  A number to uniquely identify diagnosis entries.

                  ShortDiagnosis instance identifier
                  Comments

                  Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  108. Claim.diagnosis:da.diagnosis[x]
                  Definition

                  The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                  ShortNature of illness or problem
                  Control1..1
                  BindingThe codes SHALL be taken from For example codes, see Liste des diagnostiques CIM-10 acceptable en DA pour les PMSI MCO et HADhttp://hl7.org/fhir/ValueSet/icd-10
                  (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDA)
                  TypeCodeableConcept, Reference(Condition)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Provides health context for the evaluation of the products and/or services.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  110. Claim.diagnosis:da.type
                  Definition

                  When the condition was observed or the relative ranking.

                  ShortTiming or nature of the diagnosis
                  Comments

                  For example: admitting, primary, secondary, discharge.

                  Control10..*
                  BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                  (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                  The type of the diagnosis: admitting, principal, discharge.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Often required to capture a particular diagnosis, for example: primary or discharge.

                  Fixed Value{
                    "coding" : [{
                      "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
                      "code" : "DA"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  112. Claim.diagnosis:dad
                  Slice Namedad
                  Definition

                  Information about diagnoses relevant to the claim items.

                  ShortPertinent diagnosis information
                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Required for the adjudication by provided context for the services and product listed.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  114. Claim.diagnosis:dad.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  116. Claim.diagnosis:dad.sequence
                  Definition

                  A number to uniquely identify diagnosis entries.

                  ShortDiagnosis instance identifier
                  Comments

                  Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  118. Claim.diagnosis:dad.diagnosis[x]
                  Definition

                  The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                  ShortNature of illness or problem
                  Control1..1
                  BindingThe codes SHALL be taken from For example codes, see Liste des diagnostiques CIM-10 pour le PMSIhttp://hl7.org/fhir/ValueSet/icd-10
                  (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSI)
                  TypeCodeableConcept, Reference(Condition)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Provides health context for the evaluation of the products and/or services.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  120. Claim.diagnosis:dad.type
                  Definition

                  When the condition was observed or the relative ranking.

                  ShortTiming or nature of the diagnosis
                  Comments

                  For example: admitting, primary, secondary, discharge.

                  Control10..*
                  BindingFor example codes, see ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistype
                  (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                  The type of the diagnosis: admitting, principal, discharge.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Often required to capture a particular diagnosis, for example: primary or discharge.

                  Fixed Value{
                    "coding" : [{
                      "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
                      "code" : "DAD"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  122. Claim.procedure
                  Definition

                  Procedures performed on the patient relevant to the billing items with the claim.

                  ShortClinical procedures performed
                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  124. Claim.procedure.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  126. Claim.procedure.sequence
                  Definition

                  A number to uniquely identify procedure entries.

                  ShortProcedure instance identifier
                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to provide a mechanism to link to claim details.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  128. Claim.procedure.procedure[x]
                  Definition

                  The code or reference to a Procedure resource which identifies the clinical intervention performed.

                  ShortSpecific clinical procedure
                  Control1..1
                  BindingThe codes SHALL be taken from For example codes, see Actes CCAM pour le PMSIhttp://hl7.org/fhir/ValueSet/icd-10-procedures
                  (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CCAM)
                  TypeCodeableConcept, Reference(Procedure)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  This identifies the actual clinical procedure.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  130. Claim.insurance
                  Definition

                  Financial instruments for reimbursement for the health care products and services specified on the claim.

                  ShortPatient insurance information
                  Comments

                  All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

                  Control1..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  At least one insurer is required for a claim to be a claim.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  132. Claim.insurance.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  134. Claim.insurance.sequence
                  Definition

                  A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.

                  ShortInsurance instance identifier
                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  To maintain order of the coverages.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  136. Claim.insurance.focal
                  Definition

                  A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

                  ShortCoverage to be used for adjudication
                  Comments

                  A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.

                  Control1..1
                  Typeboolean
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  To identify which coverage in the list is being used to adjudicate this claim.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  138. Claim.insurance.coverage
                  Definition

                  Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

                  ShortInsurance information
                  Control1..1
                  TypeReference(Coverage)
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Required to allow the adjudicator to locate the correct policy and history within their information system.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                  Guidance on how to interpret the contents of this table can be found here

                  0. Claim
                  Definition

                  A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

                  ShortClaim, Pre-determination or Pre-authorization
                  Comments

                  The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.

                  Control0..*
                  Is Modifierfalse
                  Summaryfalse
                  Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
                  Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                  dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                  dom-6: A resource should have narrative for robust management (text.`div`.exists())
                  2. Claim.id
                  Definition

                  The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                  ShortLogical id of this artifact
                  Comments

                  The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                  Control0..1
                  Typeid
                  Is Modifierfalse
                  Summarytrue
                  4. Claim.meta
                  Definition

                  The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                  ShortMetadata about the resource
                  Control0..1
                  TypeMeta
                  Is Modifierfalse
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  6. Claim.implicitRules
                  Definition

                  A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                  ShortA set of rules under which this content was created
                  Comments

                  Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                  Control0..1
                  Typeuri
                  Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  8. Claim.language
                  Definition

                  The base language in which the resource is written.

                  ShortLanguage of the resource content
                  Comments

                  Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                  Control0..1
                  BindingThe codes SHOULD be taken from CommonLanguages
                  (preferred to http://hl7.org/fhir/ValueSet/languages)

                  A human language.

                  Additional BindingsPurpose
                  AllLanguagesMax Binding
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  10. Claim.text
                  Definition

                  A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                  ShortText summary of the resource, for human interpretation
                  Comments

                  Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                  Control0..1
                  TypeNarrative
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesnarrative, html, xhtml, display
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  12. Claim.contained
                  Definition

                  These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                  ShortContained, inline Resources
                  Comments

                  This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                  Control0..*
                  TypeResource
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesinline resources, anonymous resources, contained resources
                  14. Claim.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  16. Claim.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                  Summaryfalse
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  18. Claim.identifier
                  Definition

                  A unique identifier assigned to this claim.

                  ShortBusiness Identifier for claim
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..*
                  TypeIdentifier
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Allows claims to be distinguished and referenced.

                  Alternate NamesClaim Number
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  20. Claim.status
                  Definition

                  The status of the resource instance.

                  Shortactive | cancelled | draft | entered-in-error
                  Comments

                  This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                  Control1..1
                  BindingThe codes SHALL be taken from FinancialResourceStatusCodes
                  (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

                  A code specifying the state of the resource instance.

                  Typecode
                  Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  22. Claim.type
                  Definition

                  The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

                  ShortChamp du PMSI concerné.
                  Comments

                  The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.

                  Control1..1
                  BindingThe codes SHALL be taken from ValueSet des type fr des claims
                  (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/FrClaimType)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Claim type determine the general sets of business rules applied for information requirements and adjudication.

                  Pattern Value{
                    "coding" : [{
                      "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimType",
                      "code" : "PMSIMCO"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  24. Claim.subType
                  Definition

                  A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

                  ShortMore granular claim type
                  Comments

                  This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

                  Control0..1
                  BindingFor example codes, see ExampleClaimSubTypeCodes
                  (example to http://hl7.org/fhir/ValueSet/claim-subtype)

                  A more granular claim typecode.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Some jurisdictions need a finer grained claim type for routing and adjudication.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  26. Claim.use
                  Definition

                  A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

                  Shortclaim | preauthorization | predetermination
                  Control1..1
                  BindingThe codes SHALL be taken from Use
                  (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

                  The purpose of the Claim: predetermination, preauthorization, claim.

                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  This element is required to understand the nature of the request for adjudication.

                  Pattern Valueclaim
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  28. Claim.patient
                  Definition

                  The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

                  ShortThe recipient of the products and services
                  Control1..1
                  TypeReference(Patient)
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  30. Claim.billablePeriod
                  Definition

                  The period for which charges are being submitted.

                  ShortRelevant time frame for the claim
                  Comments

                  Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.

                  Control0..1
                  TypePeriod
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  32. Claim.billablePeriod.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  34. Claim.billablePeriod.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on Claim.billablePeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 36. Claim.billablePeriod.start
                    Definition

                    The start of the period. The boundary is inclusive.

                    Shortdate d'entrée dans la première unité médicale visitée
                    Comments

                    If the low element is missing, the meaning is that the low boundary is not known.

                    Control0..1
                    This element is affected by the following invariants: per-1
                    TypedateTime
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    38. Claim.billablePeriod.end
                    Definition

                    The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                    Shortdate de sortie de la dernière unité médicale visitée
                    Comments

                    The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

                    Control0..1
                    This element is affected by the following invariants: per-1
                    TypedateTime
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    40. Claim.created
                    Definition

                    The date this resource was created.

                    ShortResource creation date
                    Comments

                    This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

                    Control1..1
                    TypedateTime
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need to record a timestamp for use by both the recipient and the issuer.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    42. Claim.enterer
                    Definition

                    Individual who created the claim, predetermination or preauthorization.

                    ShortAuthor of the claim
                    Control0..1
                    TypeReference(Practitioner, PractitionerRole)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Some jurisdictions require the contact information for personnel completing claims.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    44. Claim.insurer
                    Definition

                    The Insurer who is target of the request.

                    ShortTarget
                    Control0..1
                    TypeReference(Organization)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    46. Claim.provider
                    Definition

                    The provider which is responsible for the claim, predetermination or preauthorization.

                    ShortEntité juridique émettrice
                    Comments

                    Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

                    Control1..1
                    TypeReference(Practitioner, PractitionerRole, Organization)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    48. Claim.priority
                    Definition

                    The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

                    ShortDesired processing ugency
                    Comments

                    If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.

                    Control1..1
                    BindingFor example codes, see ProcessPriorityCodes
                    (example to http://hl7.org/fhir/ValueSet/process-priority)

                    The timeliness with which processing is required: stat, normal, deferred.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

                    Pattern Value{
                      "coding" : [{
                        "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
                        "code" : "normal"
                      }]
                    }
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    50. Claim.fundsReserve
                    Definition

                    A code to indicate whether and for whom funds are to be reserved for future claims.

                    ShortFor whom to reserve funds
                    Comments

                    This field is only used for preauthorizations.

                    Control0..1
                    BindingFor example codes, see Funds Reservation Codes
                    (example to http://hl7.org/fhir/ValueSet/fundsreserve)

                    For whom funds are to be reserved: (Patient, Provider, None).

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

                    Alternate NamesFund pre-allocation
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    52. Claim.related
                    Definition

                    Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

                    ShortPrior or corollary claims
                    Comments

                    For example, for the original treatment and follow-up exams.

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    For workplace or other accidents it is common to relate separate claims arising from the same event.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    54. Claim.related.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    56. Claim.related.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    58. Claim.related.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    60. Claim.related.claim
                    Definition

                    Reference to a related claim.

                    ShortReference to the related claim
                    Control0..1
                    TypeReference(Claim)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    For workplace or other accidents it is common to relate separate claims arising from the same event.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    62. Claim.related.relationship
                    Definition

                    A code to convey how the claims are related.

                    ShortHow the reference claim is related
                    Comments

                    For example, prior claim or umbrella.

                    Control0..1
                    BindingFor example codes, see ExampleRelatedClaimRelationshipCodes
                    (example to http://hl7.org/fhir/ValueSet/related-claim-relationship)

                    Relationship of this claim to a related Claim.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Some insurers need a declaration of the type of relationship.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    64. Claim.related.reference
                    Definition

                    An alternate organizational reference to the case or file to which this particular claim pertains.

                    ShortFile or case reference
                    Comments

                    For example, Property/Casualty insurer claim # or Workers Compensation case # .

                    Control0..1
                    TypeIdentifier
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    66. Claim.prescription
                    Definition

                    Prescription to support the dispensing of pharmacy, device or vision products.

                    ShortPrescription authorizing services and products
                    Control0..1
                    TypeReference(DeviceRequest, MedicationRequest, VisionPrescription)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Required to authorize the dispensing of controlled substances and devices.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    68. Claim.originalPrescription
                    Definition

                    Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

                    ShortOriginal prescription if superseded by fulfiller
                    Comments

                    For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

                    Control0..1
                    TypeReference(DeviceRequest, MedicationRequest, VisionPrescription)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    70. Claim.payee
                    Definition

                    The party to be reimbursed for cost of the products and services according to the terms of the policy.

                    ShortRecipient of benefits payable
                    Comments

                    Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead.

                    Control0..1
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    72. Claim.payee.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    74. Claim.payee.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    76. Claim.payee.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    78. Claim.payee.type
                    Definition

                    Type of Party to be reimbursed: subscriber, provider, other.

                    ShortCategory of recipient
                    Control1..1
                    BindingFor example codes, see Claim Payee Type Codes
                    (example to http://hl7.org/fhir/ValueSet/payeetype)

                    A code for the party to be reimbursed.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    80. Claim.payee.party
                    Definition

                    Reference to the individual or organization to whom any payment will be made.

                    ShortRecipient reference
                    Comments

                    Not required if the payee is 'subscriber' or 'provider'.

                    Control0..1
                    TypeReference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    82. Claim.referral
                    Definition

                    A reference to a referral resource.

                    ShortTreatment referral
                    Comments

                    The referral resource which lists the date, practitioner, reason and other supporting information.

                    Control0..1
                    TypeReference(ServiceRequest)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Some insurers require proof of referral to pay for services or to pay specialist rates for services.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    84. Claim.facility
                    Definition

                    Facility where the services were provided.

                    ShortServicing facility
                    Control0..1
                    TypeReference(Location)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Insurance adjudication can be dependant on where services were delivered.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    86. Claim.careTeam
                    Definition

                    The members of the team who provided the products and services.

                    ShortMembers of the care team
                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Common to identify the responsible and supporting practitioners.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    88. Claim.careTeam.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    90. Claim.careTeam.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    92. Claim.careTeam.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    94. Claim.careTeam.sequence
                    Definition

                    A number to uniquely identify care team entries.

                    ShortOrder of care team
                    Control1..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    96. Claim.careTeam.provider
                    Definition

                    Member of the team who provided the product or service.

                    ShortPractitioner or organization
                    Control1..1
                    TypeReference(Practitioner, PractitionerRole, Organization)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Often a regulatory requirement to specify the responsible provider.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    98. Claim.careTeam.responsible
                    Definition

                    The party who is billing and/or responsible for the claimed products or services.

                    ShortIndicator of the lead practitioner
                    Comments

                    Responsible might not be required when there is only a single provider listed.

                    Control0..1
                    Typeboolean
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    When multiple parties are present it is required to distinguish the lead or responsible individual.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    100. Claim.careTeam.role
                    Definition

                    The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

                    ShortFunction within the team
                    Comments

                    Role might not be required when there is only a single provider listed.

                    Control0..1
                    BindingFor example codes, see ClaimCareTeamRoleCodes
                    (example to http://hl7.org/fhir/ValueSet/claim-careteamrole)

                    The role codes for the care team members.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    When multiple parties are present it is required to distinguish the roles performed by each member.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    102. Claim.careTeam.qualification
                    Definition

                    The qualification of the practitioner which is applicable for this service.

                    ShortPractitioner credential or specialization
                    Control0..1
                    BindingFor example codes, see ExampleProviderQualificationCodes
                    (example to http://hl7.org/fhir/ValueSet/provider-qualification)

                    Provider professional qualifications.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Need to specify which qualification a provider is delivering the product or service under.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    104. Claim.supportingInfo
                    Definition

                    Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                    ShortsupportingInfo
                    Comments

                    Often there are multiple jurisdiction specific valuesets which are required.

                    Control2..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                    Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Claim.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ code.coding.code
                    • value @ code.coding.system
                    • 106. Claim.supportingInfo.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      108. Claim.supportingInfo.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      110. Claim.supportingInfo.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      112. Claim.supportingInfo.sequence
                      Definition

                      A number to uniquely identify supporting information entries.

                      ShortInformation instance identifier
                      Control1..1
                      TypepositiveInt
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      114. Claim.supportingInfo.category
                      Definition

                      The general class of the information supplied: information; exception; accident, employment; onset, etc.

                      ShortClassification of the supplied information
                      Comments

                      This may contain a category for the local bill type codes.

                      Control1..1
                      BindingFor example codes, see ClaimInformationCategoryCodes
                      (example to http://hl7.org/fhir/ValueSet/claim-informationcategory)

                      The valuset used for additional information category codes.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      116. Claim.supportingInfo.code
                      Definition

                      System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                      ShortType of information
                      Control0..1
                      BindingFor example codes, see ExceptionCodes
                      (example to http://hl7.org/fhir/ValueSet/claim-exception)

                      The valuset used for additional information codes.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Required to identify the kind of additional information.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      118. Claim.supportingInfo.timing[x]
                      Definition

                      The date when or period to which this information refers.

                      ShortWhen it occurred
                      Control0..1
                      TypeChoice of: date, Period
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      120. Claim.supportingInfo.value[x]
                      Definition

                      Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                      ShortData to be provided
                      Comments

                      Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

                      Control0..1
                      TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      To convey the data content to be provided when the information is more than a simple code or period.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      122. Claim.supportingInfo.reason
                      Definition

                      Provides the reason in the situation where a reason code is required in addition to the content.

                      ShortExplanation for the information
                      Comments

                      For example: the reason for the additional stay, or why a tooth is missing.

                      Control0..1
                      BindingFor example codes, see MissingToothReasonCodes
                      (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                      Reason codes for the missing teeth.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Needed when the supporting information has both a date and amount/value and requires explanation.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      124. Claim.supportingInfo:ModeIn
                      Slice NameModeIn
                      Definition

                      Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                      ShortSupporting information
                      Comments

                      Often there are multiple jurisdiction specific valuesets which are required.

                      Control1..1
                      TypeBackboneElement
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                      Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      126. Claim.supportingInfo:ModeIn.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      128. Claim.supportingInfo:ModeIn.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      130. Claim.supportingInfo:ModeIn.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      132. Claim.supportingInfo:ModeIn.sequence
                      Definition

                      A number to uniquely identify supporting information entries.

                      ShortInformation instance identifier
                      Control1..1
                      TypepositiveInt
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      134. Claim.supportingInfo:ModeIn.category
                      Definition

                      The general class of the information supplied: information; exception; accident, employment; onset, etc.

                      ShortClassification of the supplied information
                      Comments

                      This may contain a category for the local bill type codes.

                      Control1..1
                      BindingFor example codes, see ClaimInformationCategoryCodes
                      (example to http://hl7.org/fhir/ValueSet/claim-informationcategory)

                      The valuset used for additional information category codes.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                      Fixed Value{
                        "coding" : [{
                          "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO",
                          "code" : "RUM"
                        }]
                      }
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      136. Claim.supportingInfo:ModeIn.code
                      Definition

                      System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                      ShortType of information
                      Control0..1
                      BindingFor example codes, see ExceptionCodes
                      (example to http://hl7.org/fhir/ValueSet/claim-exception)

                      The valuset used for additional information codes.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Required to identify the kind of additional information.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      138. Claim.supportingInfo:ModeIn.code.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      140. Claim.supportingInfo:ModeIn.code.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on Claim.supportingInfo.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 142. Claim.supportingInfo:ModeIn.code.coding
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                        Control1..*
                        TypeCoding
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Allows for alternative encodings within a code system, and translations to other code systems.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on Claim.supportingInfo.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ code
                        • value @ system
                        • 144. Claim.supportingInfo:ModeIn.code.coding:ModeInCode
                          Slice NameModeInCode
                          Definition

                          A reference to a code defined by a terminology system.

                          ShortCode defined by a terminology system
                          Comments

                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                          Control1..1
                          TypeCoding
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Requirements

                          Allows for alternative encodings within a code system, and translations to other code systems.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          146. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.id
                          Definition

                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          148. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on Claim.supportingInfo.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 150. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.system
                            Definition

                            The identification of the code system that defines the meaning of the symbol in the code.

                            ShortIdentity of the terminology system
                            Comments

                            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to be unambiguous about the source of the definition of the symbol.

                            Fixed Valuehttps://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            152. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.version
                            Definition

                            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                            ShortVersion of the system - if relevant
                            Comments

                            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                            NoteThis is a business version Id, not a resource version Id (see discussion)
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            154. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.code
                            Definition

                            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                            ShortSymbol in syntax defined by the system
                            Control1..1
                            Typecode
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to refer to a particular code in the system.

                            Fixed Value0
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            156. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.display
                            Definition

                            A representation of the meaning of the code in the system, following the rules of the system.

                            ShortRepresentation defined by the system
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            158. Claim.supportingInfo:ModeIn.code.coding:ModeInCode.userSelected
                            Definition

                            Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                            ShortIf this coding was chosen directly by the user
                            Comments

                            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                            Control0..1
                            Typeboolean
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            160. Claim.supportingInfo:ModeIn.code.text
                            Definition

                            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                            ShortPlain text representation of the concept
                            Comments

                            Very often the text is the same as a displayName of one of the codings.

                            Control0..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            162. Claim.supportingInfo:ModeIn.timing[x]
                            Definition

                            The date when or period to which this information refers.

                            ShortWhen it occurred
                            Control0..1
                            TypeChoice of: date, Period
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            164. Claim.supportingInfo:ModeIn.value[x]
                            Definition

                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                            Shortvaleur du mode d'entrée
                            Comments

                            Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

                            Control0..1
                            Typestring
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            To convey the data content to be provided when the information is more than a simple code or period.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            166. Claim.supportingInfo:ModeIn.reason
                            Definition

                            Provides the reason in the situation where a reason code is required in addition to the content.

                            ShortExplanation for the information
                            Comments

                            For example: the reason for the additional stay, or why a tooth is missing.

                            Control0..1
                            BindingFor example codes, see MissingToothReasonCodes
                            (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                            Reason codes for the missing teeth.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Needed when the supporting information has both a date and amount/value and requires explanation.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            168. Claim.supportingInfo:ModeOut
                            Slice NameModeOut
                            Definition

                            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                            ShortSupporting information
                            Comments

                            Often there are multiple jurisdiction specific valuesets which are required.

                            Control1..1
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                            Alternate NamesAttachments Exception Codes Occurrence Codes Value codes
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            170. Claim.supportingInfo:ModeOut.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            172. Claim.supportingInfo:ModeOut.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            174. Claim.supportingInfo:ModeOut.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            176. Claim.supportingInfo:ModeOut.sequence
                            Definition

                            A number to uniquely identify supporting information entries.

                            ShortInformation instance identifier
                            Control1..1
                            TypepositiveInt
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            178. Claim.supportingInfo:ModeOut.category
                            Definition

                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                            ShortClassification of the supplied information
                            Comments

                            This may contain a category for the local bill type codes.

                            Control1..1
                            BindingFor example codes, see ClaimInformationCategoryCodes
                            (example to http://hl7.org/fhir/ValueSet/claim-informationcategory)

                            The valuset used for additional information category codes.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                            Fixed Value{
                              "coding" : [{
                                "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO",
                                "code" : "RUM"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            180. Claim.supportingInfo:ModeOut.code
                            Definition

                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                            ShortType of information
                            Control0..1
                            BindingFor example codes, see ExceptionCodes
                            (example to http://hl7.org/fhir/ValueSet/claim-exception)

                            The valuset used for additional information codes.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Required to identify the kind of additional information.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            182. Claim.supportingInfo:ModeOut.code.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            184. Claim.supportingInfo:ModeOut.code.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on Claim.supportingInfo.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 186. Claim.supportingInfo:ModeOut.code.coding
                              Definition

                              A reference to a code defined by a terminology system.

                              ShortCode defined by a terminology system
                              Comments

                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                              Control1..*
                              TypeCoding
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Allows for alternative encodings within a code system, and translations to other code systems.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              SlicingThis element introduces a set of slices on Claim.supportingInfo.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ code
                              • value @ system
                              • 188. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode
                                Slice NameModeOutCode
                                Definition

                                A reference to a code defined by a terminology system.

                                ShortCode defined by a terminology system
                                Comments

                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                Control1..1
                                TypeCoding
                                Is Modifierfalse
                                Must Supporttrue
                                Summarytrue
                                Requirements

                                Allows for alternative encodings within a code system, and translations to other code systems.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                190. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.id
                                Definition

                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                192. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                SlicingThis element introduces a set of slices on Claim.supportingInfo.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 194. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.system
                                  Definition

                                  The identification of the code system that defines the meaning of the symbol in the code.

                                  ShortIdentity of the terminology system
                                  Comments

                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                  Control1..1
                                  Typeuri
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to be unambiguous about the source of the definition of the symbol.

                                  Fixed Valuehttps://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  196. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.version
                                  Definition

                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                  ShortVersion of the system - if relevant
                                  Comments

                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  198. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.code
                                  Definition

                                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                  ShortSymbol in syntax defined by the system
                                  Control1..1
                                  Typecode
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to refer to a particular code in the system.

                                  Fixed Value1
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  200. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.display
                                  Definition

                                  A representation of the meaning of the code in the system, following the rules of the system.

                                  ShortRepresentation defined by the system
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  202. Claim.supportingInfo:ModeOut.code.coding:ModeOutCode.userSelected
                                  Definition

                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                  ShortIf this coding was chosen directly by the user
                                  Comments

                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                  Control0..1
                                  Typeboolean
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  204. Claim.supportingInfo:ModeOut.code.text
                                  Definition

                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                  ShortPlain text representation of the concept
                                  Comments

                                  Very often the text is the same as a displayName of one of the codings.

                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  206. Claim.supportingInfo:ModeOut.timing[x]
                                  Definition

                                  The date when or period to which this information refers.

                                  ShortWhen it occurred
                                  Control0..1
                                  TypeChoice of: date, Period
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  208. Claim.supportingInfo:ModeOut.value[x]
                                  Definition

                                  Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                  Shortvaleur du mode de sortie
                                  Comments

                                  Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.

                                  Control0..1
                                  Typestring
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Summaryfalse
                                  Requirements

                                  To convey the data content to be provided when the information is more than a simple code or period.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  210. Claim.supportingInfo:ModeOut.reason
                                  Definition

                                  Provides the reason in the situation where a reason code is required in addition to the content.

                                  ShortExplanation for the information
                                  Comments

                                  For example: the reason for the additional stay, or why a tooth is missing.

                                  Control0..1
                                  BindingFor example codes, see MissingToothReasonCodes
                                  (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                  Reason codes for the missing teeth.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  Needed when the supporting information has both a date and amount/value and requires explanation.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  212. Claim.diagnosis
                                  Definition

                                  Information about diagnoses relevant to the claim items.

                                  ShortPertinent diagnosis information
                                  Control1..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Requirements

                                  Required for the adjudication by provided context for the services and product listed.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  SlicingThis element introduces a set of slices on Claim.diagnosis. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ type
                                  • 214. Claim.diagnosis.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    216. Claim.diagnosis.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    218. Claim.diagnosis.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    220. Claim.diagnosis.sequence
                                    Definition

                                    A number to uniquely identify diagnosis entries.

                                    ShortDiagnosis instance identifier
                                    Comments

                                    Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    222. Claim.diagnosis.diagnosis[x]
                                    Definition

                                    The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                    ShortNature of illness or problem
                                    Control1..1
                                    BindingFor example codes, see ICD-10Codes
                                    (example to http://hl7.org/fhir/ValueSet/icd-10)

                                    Example ICD10 Diagnostic codes.

                                    TypeChoice of: CodeableConcept, Reference(Condition)
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Provides health context for the evaluation of the products and/or services.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    224. Claim.diagnosis.type
                                    Definition

                                    When the condition was observed or the relative ranking.

                                    ShortTiming or nature of the diagnosis
                                    Comments

                                    For example: admitting, primary, secondary, discharge.

                                    Control0..*
                                    BindingFor example codes, see ExampleDiagnosisTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                                    The type of the diagnosis: admitting, principal, discharge.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Often required to capture a particular diagnosis, for example: primary or discharge.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    226. Claim.diagnosis.onAdmission
                                    Definition

                                    Indication of whether the diagnosis was present on admission to a facility.

                                    ShortPresent on admission
                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                    Present on admission.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    228. Claim.diagnosis.packageCode
                                    Definition

                                    A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

                                    ShortPackage billing code
                                    Comments

                                    For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                    The DRG codes associated with the diagnosis.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    230. Claim.diagnosis:dp
                                    Slice Namedp
                                    Definition

                                    Information about diagnoses relevant to the claim items.

                                    ShortPertinent diagnosis information
                                    Control1..1
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Requirements

                                    Required for the adjudication by provided context for the services and product listed.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    232. Claim.diagnosis:dp.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    234. Claim.diagnosis:dp.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    236. Claim.diagnosis:dp.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    238. Claim.diagnosis:dp.sequence
                                    Definition

                                    A number to uniquely identify diagnosis entries.

                                    ShortDiagnosis instance identifier
                                    Comments

                                    Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    240. Claim.diagnosis:dp.diagnosis[x]
                                    Definition

                                    The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                    ShortNature of illness or problem
                                    Control1..1
                                    BindingThe codes SHALL be taken from Liste des diagnostiques CIM-10 acceptable en DP pour les PMSI MCO et HAD
                                    (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDP)
                                    TypeCodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Provides health context for the evaluation of the products and/or services.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    242. Claim.diagnosis:dp.type
                                    Definition

                                    When the condition was observed or the relative ranking.

                                    ShortTiming or nature of the diagnosis
                                    Comments

                                    For example: admitting, primary, secondary, discharge.

                                    Control1..*
                                    BindingFor example codes, see ExampleDiagnosisTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                                    The type of the diagnosis: admitting, principal, discharge.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Often required to capture a particular diagnosis, for example: primary or discharge.

                                    Fixed Value{
                                      "coding" : [{
                                        "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
                                        "code" : "DP"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    244. Claim.diagnosis:dp.onAdmission
                                    Definition

                                    Indication of whether the diagnosis was present on admission to a facility.

                                    ShortPresent on admission
                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                    Present on admission.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    246. Claim.diagnosis:dp.packageCode
                                    Definition

                                    A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

                                    ShortPackage billing code
                                    Comments

                                    For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                    The DRG codes associated with the diagnosis.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    248. Claim.diagnosis:dr
                                    Slice Namedr
                                    Definition

                                    Information about diagnoses relevant to the claim items.

                                    ShortPertinent diagnosis information
                                    Control0..1
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Requirements

                                    Required for the adjudication by provided context for the services and product listed.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    250. Claim.diagnosis:dr.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    252. Claim.diagnosis:dr.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    254. Claim.diagnosis:dr.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    256. Claim.diagnosis:dr.sequence
                                    Definition

                                    A number to uniquely identify diagnosis entries.

                                    ShortDiagnosis instance identifier
                                    Comments

                                    Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    258. Claim.diagnosis:dr.diagnosis[x]
                                    Definition

                                    The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                    ShortNature of illness or problem
                                    Control1..1
                                    BindingThe codes SHALL be taken from Liste des diagnostiques CIM-10 acceptable en DR pour les PMSI MCO et HAD
                                    (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDR)
                                    TypeCodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Provides health context for the evaluation of the products and/or services.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    260. Claim.diagnosis:dr.type
                                    Definition

                                    When the condition was observed or the relative ranking.

                                    ShortTiming or nature of the diagnosis
                                    Comments

                                    For example: admitting, primary, secondary, discharge.

                                    Control1..*
                                    BindingFor example codes, see ExampleDiagnosisTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                                    The type of the diagnosis: admitting, principal, discharge.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Often required to capture a particular diagnosis, for example: primary or discharge.

                                    Fixed Value{
                                      "coding" : [{
                                        "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
                                        "code" : "DR"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    262. Claim.diagnosis:dr.onAdmission
                                    Definition

                                    Indication of whether the diagnosis was present on admission to a facility.

                                    ShortPresent on admission
                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                    Present on admission.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    264. Claim.diagnosis:dr.packageCode
                                    Definition

                                    A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

                                    ShortPackage billing code
                                    Comments

                                    For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                    The DRG codes associated with the diagnosis.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    266. Claim.diagnosis:da
                                    Slice Nameda
                                    Definition

                                    Information about diagnoses relevant to the claim items.

                                    ShortPertinent diagnosis information
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Requirements

                                    Required for the adjudication by provided context for the services and product listed.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    268. Claim.diagnosis:da.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    270. Claim.diagnosis:da.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    272. Claim.diagnosis:da.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    274. Claim.diagnosis:da.sequence
                                    Definition

                                    A number to uniquely identify diagnosis entries.

                                    ShortDiagnosis instance identifier
                                    Comments

                                    Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    276. Claim.diagnosis:da.diagnosis[x]
                                    Definition

                                    The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                    ShortNature of illness or problem
                                    Control1..1
                                    BindingThe codes SHALL be taken from Liste des diagnostiques CIM-10 acceptable en DA pour les PMSI MCO et HAD
                                    (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDA)
                                    TypeCodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Provides health context for the evaluation of the products and/or services.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    278. Claim.diagnosis:da.type
                                    Definition

                                    When the condition was observed or the relative ranking.

                                    ShortTiming or nature of the diagnosis
                                    Comments

                                    For example: admitting, primary, secondary, discharge.

                                    Control1..*
                                    BindingFor example codes, see ExampleDiagnosisTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                                    The type of the diagnosis: admitting, principal, discharge.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Often required to capture a particular diagnosis, for example: primary or discharge.

                                    Fixed Value{
                                      "coding" : [{
                                        "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
                                        "code" : "DA"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    280. Claim.diagnosis:da.onAdmission
                                    Definition

                                    Indication of whether the diagnosis was present on admission to a facility.

                                    ShortPresent on admission
                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                    Present on admission.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    282. Claim.diagnosis:da.packageCode
                                    Definition

                                    A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

                                    ShortPackage billing code
                                    Comments

                                    For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                    The DRG codes associated with the diagnosis.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    284. Claim.diagnosis:dad
                                    Slice Namedad
                                    Definition

                                    Information about diagnoses relevant to the claim items.

                                    ShortPertinent diagnosis information
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Requirements

                                    Required for the adjudication by provided context for the services and product listed.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    286. Claim.diagnosis:dad.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    288. Claim.diagnosis:dad.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    290. Claim.diagnosis:dad.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    292. Claim.diagnosis:dad.sequence
                                    Definition

                                    A number to uniquely identify diagnosis entries.

                                    ShortDiagnosis instance identifier
                                    Comments

                                    Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    294. Claim.diagnosis:dad.diagnosis[x]
                                    Definition

                                    The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                    ShortNature of illness or problem
                                    Control1..1
                                    BindingThe codes SHALL be taken from Liste des diagnostiques CIM-10 pour le PMSI
                                    (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSI)
                                    TypeCodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Provides health context for the evaluation of the products and/or services.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    296. Claim.diagnosis:dad.type
                                    Definition

                                    When the condition was observed or the relative ranking.

                                    ShortTiming or nature of the diagnosis
                                    Comments

                                    For example: admitting, primary, secondary, discharge.

                                    Control1..*
                                    BindingFor example codes, see ExampleDiagnosisTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosistype)

                                    The type of the diagnosis: admitting, principal, discharge.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Often required to capture a particular diagnosis, for example: primary or discharge.

                                    Fixed Value{
                                      "coding" : [{
                                        "system" : "https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType",
                                        "code" : "DAD"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    298. Claim.diagnosis:dad.onAdmission
                                    Definition

                                    Indication of whether the diagnosis was present on admission to a facility.

                                    ShortPresent on admission
                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                    Present on admission.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    300. Claim.diagnosis:dad.packageCode
                                    Definition

                                    A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

                                    ShortPackage billing code
                                    Comments

                                    For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

                                    Control0..1
                                    BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                    The DRG codes associated with the diagnosis.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    302. Claim.procedure
                                    Definition

                                    Procedures performed on the patient relevant to the billing items with the claim.

                                    ShortClinical procedures performed
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Requirements

                                    The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    304. Claim.procedure.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    306. Claim.procedure.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    308. Claim.procedure.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    310. Claim.procedure.sequence
                                    Definition

                                    A number to uniquely identify procedure entries.

                                    ShortProcedure instance identifier
                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to provide a mechanism to link to claim details.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    312. Claim.procedure.type
                                    Definition

                                    When the condition was observed or the relative ranking.

                                    ShortCategory of Procedure
                                    Comments

                                    For example: primary, secondary.

                                    Control0..*
                                    BindingFor example codes, see ExampleProcedureTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-procedure-type)

                                    Example procedure type codes.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Often required to capture a particular diagnosis, for example: primary or discharge.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    314. Claim.procedure.date
                                    Definition

                                    Date and optionally time the procedure was performed.

                                    ShortWhen the procedure was performed
                                    Control0..1
                                    TypedateTime
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Required for auditing purposes.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    316. Claim.procedure.procedure[x]
                                    Definition

                                    The code or reference to a Procedure resource which identifies the clinical intervention performed.

                                    ShortSpecific clinical procedure
                                    Control1..1
                                    BindingThe codes SHALL be taken from Actes CCAM pour le PMSI
                                    (required to https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CCAM)
                                    TypeCodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    This identifies the actual clinical procedure.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    318. Claim.procedure.udi
                                    Definition

                                    Unique Device Identifiers associated with this line item.

                                    ShortUnique device identifier
                                    Control0..*
                                    TypeReference(Device)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The UDI code allows the insurer to obtain device level information on the product supplied.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    320. Claim.insurance
                                    Definition

                                    Financial instruments for reimbursement for the health care products and services specified on the claim.

                                    ShortPatient insurance information
                                    Comments

                                    All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

                                    Control1..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summarytrue
                                    Requirements

                                    At least one insurer is required for a claim to be a claim.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    322. Claim.insurance.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    324. Claim.insurance.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    326. Claim.insurance.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    328. Claim.insurance.sequence
                                    Definition

                                    A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.

                                    ShortInsurance instance identifier
                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    To maintain order of the coverages.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    330. Claim.insurance.focal
                                    Definition

                                    A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

                                    ShortCoverage to be used for adjudication
                                    Comments

                                    A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.

                                    Control1..1
                                    Typeboolean
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    To identify which coverage in the list is being used to adjudicate this claim.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    332. Claim.insurance.identifier
                                    Definition

                                    The business identifier to be used when the claim is sent for adjudication against this insurance policy.

                                    ShortPre-assigned Claim number
                                    Comments

                                    Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'.

                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                    Control0..1
                                    TypeIdentifier
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    334. Claim.insurance.coverage
                                    Definition

                                    Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

                                    ShortInsurance information
                                    Control1..1
                                    TypeReference(Coverage)
                                    Is Modifierfalse
                                    Summarytrue
                                    Requirements

                                    Required to allow the adjudicator to locate the correct policy and history within their information system.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    336. Claim.insurance.businessArrangement
                                    Definition

                                    A business agreement number established between the provider and the insurer for special business processing purposes.

                                    ShortAdditional provider contract number
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    338. Claim.insurance.preAuthRef
                                    Definition

                                    Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.

                                    ShortPrior authorization reference number
                                    Comments

                                    This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.

                                    Control0..*
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    340. Claim.insurance.claimResponse
                                    Definition

                                    The result of the adjudication of the line items for the Coverage specified in this insurance.

                                    ShortAdjudication results
                                    Comments

                                    Must not be specified when 'focal=true' for this insurance.

                                    Control0..1
                                    TypeReference(ClaimResponse)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    342. Claim.accident
                                    Definition

                                    Details of an accident which resulted in injuries which required the products and services listed in the claim.

                                    ShortDetails of the event
                                    Control0..1
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    344. Claim.accident.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    346. Claim.accident.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    348. Claim.accident.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    350. Claim.accident.date
                                    Definition

                                    Date of an accident event related to the products and services contained in the claim.

                                    ShortWhen the incident occurred
                                    Comments

                                    The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.

                                    Control1..1
                                    Typedate
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Required for audit purposes and adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    352. Claim.accident.type
                                    Definition

                                    The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.

                                    ShortThe nature of the accident
                                    Control0..1
                                    BindingUnless not suitable, these codes SHALL be taken from ActIncidentCode
                                    (extensible to http://terminology.hl7.org/ValueSet/v3-ActIncidentCode)

                                    Type of accident: work place, auto, etc.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Coverage may be dependant on the type of accident.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    354. Claim.accident.location[x]
                                    Definition

                                    The physical location of the accident event.

                                    ShortWhere the event occurred
                                    Control0..1
                                    TypeChoice of: Address, Reference(Location)
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required for audit purposes and determination of applicable insurance liability.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    356. Claim.item
                                    Definition

                                    A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

                                    ShortProduct or service provided
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The items to be processed for adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    358. Claim.item.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    360. Claim.item.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    362. Claim.item.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    364. Claim.item.sequence
                                    Definition

                                    A number to uniquely identify item entries.

                                    ShortItem instance identifier
                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    366. Claim.item.careTeamSequence
                                    Definition

                                    CareTeam members related to this service or product.

                                    ShortApplicable careTeam members
                                    Control0..*
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Need to identify the individuals and their roles in the provision of the product or service.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    368. Claim.item.diagnosisSequence
                                    Definition

                                    Diagnosis applicable for this service or product.

                                    ShortApplicable diagnoses
                                    Control0..*
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Need to related the product or service to the associated diagnoses.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    370. Claim.item.procedureSequence
                                    Definition

                                    Procedures applicable for this service or product.

                                    ShortApplicable procedures
                                    Control0..*
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Need to provide any listed specific procedures to support the product or service being claimed.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    372. Claim.item.informationSequence
                                    Definition

                                    Exceptions, special conditions and supporting information applicable for this service or product.

                                    ShortApplicable exception and supporting information
                                    Control0..*
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Need to reference the supporting information items that relate directly to this product or service.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    374. Claim.item.revenue
                                    Definition

                                    The type of revenue or cost center providing the product and/or service.

                                    ShortRevenue or cost center code
                                    Control0..1
                                    BindingFor example codes, see ExampleRevenueCenterCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                    Codes for the revenue or cost centers supplying the service and/or products.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Needed in the processing of institutional claims.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    376. Claim.item.category
                                    Definition

                                    Code to identify the general type of benefits under which products and services are provided.

                                    ShortBenefit classification
                                    Comments

                                    Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                    Control0..1
                                    BindingFor example codes, see BenefitCategoryCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                    Benefit categories such as: oral-basic, major, glasses.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    378. Claim.item.productOrService
                                    Definition

                                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                    ShortBilling, service, product, or drug code
                                    Comments

                                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                    Control1..1
                                    BindingFor example codes, see USCLSCodes
                                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                    Allowable service and product codes.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Necessary to state what was provided or done.

                                    Alternate NamesDrug Code, Bill Code, Service Code
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    380. Claim.item.modifier
                                    Definition

                                    Item typification or modifiers codes to convey additional context for the product or service.

                                    ShortProduct or service billing modifiers
                                    Comments

                                    For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

                                    Control0..*
                                    BindingFor example codes, see ModifierTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    To support inclusion of the item for adjudication or to charge an elevated fee.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    382. Claim.item.programCode
                                    Definition

                                    Identifies the program under which this may be recovered.

                                    ShortProgram the product or service is provided under
                                    Comments

                                    For example: Neonatal program, child dental program or drug users recovery program.

                                    Control0..*
                                    BindingFor example codes, see ExampleProgramReasonCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                    Program specific reason codes.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    384. Claim.item.serviced[x]
                                    Definition

                                    The date or dates when the service or product was supplied, performed or completed.

                                    ShortDate or dates of service or product delivery
                                    Control0..1
                                    TypeChoice of: date, Period
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Needed to determine whether the service or product was provided during the term of the insurance coverage.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    386. Claim.item.location[x]
                                    Definition

                                    Where the product or service was provided.

                                    ShortPlace of service or where product was supplied
                                    Control0..1
                                    BindingFor example codes, see ExampleServicePlaceCodes
                                    (example to http://hl7.org/fhir/ValueSet/service-place)

                                    Place of service: pharmacy, school, prison, etc.

                                    TypeChoice of: CodeableConcept, Address, Reference(Location)
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    388. Claim.item.quantity
                                    Definition

                                    The number of repetitions of a service or product.

                                    ShortCount of products or services
                                    Control0..1
                                    TypeQuantity(SimpleQuantity)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required when the product or service code does not convey the quantity provided.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    390. Claim.item.unitPrice
                                    Definition

                                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                    ShortFee, charge or cost per item
                                    Control0..1
                                    TypeMoney
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The amount charged to the patient by the provider for a single unit.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    392. Claim.item.factor
                                    Definition

                                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                    ShortPrice scaling factor
                                    Comments

                                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                    Control0..1
                                    Typedecimal
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    394. Claim.item.net
                                    Definition

                                    The quantity times the unit price for an additional service or product or charge.

                                    ShortTotal item cost
                                    Comments

                                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                    Control0..1
                                    TypeMoney
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Provides the total amount claimed for the group (if a grouper) or the line item.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    396. Claim.item.udi
                                    Definition

                                    Unique Device Identifiers associated with this line item.

                                    ShortUnique device identifier
                                    Control0..*
                                    TypeReference(Device)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The UDI code allows the insurer to obtain device level information on the product supplied.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    398. Claim.item.bodySite
                                    Definition

                                    Physical service site on the patient (limb, tooth, etc.).

                                    ShortAnatomical location
                                    Comments

                                    For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

                                    Control0..1
                                    BindingFor example codes, see OralSiteCodes
                                    (example to http://hl7.org/fhir/ValueSet/tooth)

                                    The code for the teeth, quadrant, sextant and arch.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Allows insurer to validate specific procedures.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    400. Claim.item.subSite
                                    Definition

                                    A region or surface of the bodySite, e.g. limb region or tooth surface(s).

                                    ShortAnatomical sub-location
                                    Control0..*
                                    BindingFor example codes, see SurfaceCodes
                                    (example to http://hl7.org/fhir/ValueSet/surface)

                                    The code for the tooth surface and surface combinations.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Allows insurer to validate specific procedures.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    402. Claim.item.encounter
                                    Definition

                                    The Encounters during which this Claim was created or to which the creation of this record is tightly associated.

                                    ShortEncounters related to this billed item
                                    Comments

                                    This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

                                    Control0..*
                                    TypeReference(Encounter)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Used in some jurisdictions to link clinical events to claim items.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    404. Claim.item.detail
                                    Definition

                                    A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                                    ShortProduct or service provided
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The items to be processed for adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    406. Claim.item.detail.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    408. Claim.item.detail.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    410. Claim.item.detail.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    412. Claim.item.detail.sequence
                                    Definition

                                    A number to uniquely identify item entries.

                                    ShortItem instance identifier
                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    414. Claim.item.detail.revenue
                                    Definition

                                    The type of revenue or cost center providing the product and/or service.

                                    ShortRevenue or cost center code
                                    Control0..1
                                    BindingFor example codes, see ExampleRevenueCenterCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                    Codes for the revenue or cost centers supplying the service and/or products.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Needed in the processing of institutional claims.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    416. Claim.item.detail.category
                                    Definition

                                    Code to identify the general type of benefits under which products and services are provided.

                                    ShortBenefit classification
                                    Comments

                                    Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                    Control0..1
                                    BindingFor example codes, see BenefitCategoryCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                    Benefit categories such as: oral-basic, major, glasses.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    418. Claim.item.detail.productOrService
                                    Definition

                                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                    ShortBilling, service, product, or drug code
                                    Comments

                                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                    Control1..1
                                    BindingFor example codes, see USCLSCodes
                                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                    Allowable service and product codes.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Necessary to state what was provided or done.

                                    Alternate NamesDrug Code, Bill Code, Service Code
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    420. Claim.item.detail.modifier
                                    Definition

                                    Item typification or modifiers codes to convey additional context for the product or service.

                                    ShortService/Product billing modifiers
                                    Comments

                                    For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                    Control0..*
                                    BindingFor example codes, see ModifierTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    To support inclusion of the item for adjudication or to charge an elevated fee.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    422. Claim.item.detail.programCode
                                    Definition

                                    Identifies the program under which this may be recovered.

                                    ShortProgram the product or service is provided under
                                    Comments

                                    For example: Neonatal program, child dental program or drug users recovery program.

                                    Control0..*
                                    BindingFor example codes, see ExampleProgramReasonCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                    Program specific reason codes.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    424. Claim.item.detail.quantity
                                    Definition

                                    The number of repetitions of a service or product.

                                    ShortCount of products or services
                                    Control0..1
                                    TypeQuantity(SimpleQuantity)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required when the product or service code does not convey the quantity provided.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    426. Claim.item.detail.unitPrice
                                    Definition

                                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                    ShortFee, charge or cost per item
                                    Control0..1
                                    TypeMoney
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The amount charged to the patient by the provider for a single unit.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    428. Claim.item.detail.factor
                                    Definition

                                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                    ShortPrice scaling factor
                                    Comments

                                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                    Control0..1
                                    Typedecimal
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    430. Claim.item.detail.net
                                    Definition

                                    The quantity times the unit price for an additional service or product or charge.

                                    ShortTotal item cost
                                    Comments

                                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                    Control0..1
                                    TypeMoney
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Provides the total amount claimed for the group (if a grouper) or the line item.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    432. Claim.item.detail.udi
                                    Definition

                                    Unique Device Identifiers associated with this line item.

                                    ShortUnique device identifier
                                    Control0..*
                                    TypeReference(Device)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The UDI code allows the insurer to obtain device level information on the product supplied.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    434. Claim.item.detail.subDetail
                                    Definition

                                    A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                                    ShortProduct or service provided
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The items to be processed for adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    436. Claim.item.detail.subDetail.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    438. Claim.item.detail.subDetail.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    440. Claim.item.detail.subDetail.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    442. Claim.item.detail.subDetail.sequence
                                    Definition

                                    A number to uniquely identify item entries.

                                    ShortItem instance identifier
                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    444. Claim.item.detail.subDetail.revenue
                                    Definition

                                    The type of revenue or cost center providing the product and/or service.

                                    ShortRevenue or cost center code
                                    Control0..1
                                    BindingFor example codes, see ExampleRevenueCenterCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                    Codes for the revenue or cost centers supplying the service and/or products.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Needed in the processing of institutional claims.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    446. Claim.item.detail.subDetail.category
                                    Definition

                                    Code to identify the general type of benefits under which products and services are provided.

                                    ShortBenefit classification
                                    Comments

                                    Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                    Control0..1
                                    BindingFor example codes, see BenefitCategoryCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                    Benefit categories such as: oral-basic, major, glasses.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    448. Claim.item.detail.subDetail.productOrService
                                    Definition

                                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                    ShortBilling, service, product, or drug code
                                    Comments

                                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                    Control1..1
                                    BindingFor example codes, see USCLSCodes
                                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                    Allowable service and product codes.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Necessary to state what was provided or done.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    450. Claim.item.detail.subDetail.modifier
                                    Definition

                                    Item typification or modifiers codes to convey additional context for the product or service.

                                    ShortService/Product billing modifiers
                                    Comments

                                    For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                    Control0..*
                                    BindingFor example codes, see ModifierTypeCodes
                                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    To support inclusion of the item for adjudication or to charge an elevated fee.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    452. Claim.item.detail.subDetail.programCode
                                    Definition

                                    Identifies the program under which this may be recovered.

                                    ShortProgram the product or service is provided under
                                    Comments

                                    For example: Neonatal program, child dental program or drug users recovery program.

                                    Control0..*
                                    BindingFor example codes, see ExampleProgramReasonCodes
                                    (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                    Program specific reason codes.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    454. Claim.item.detail.subDetail.quantity
                                    Definition

                                    The number of repetitions of a service or product.

                                    ShortCount of products or services
                                    Control0..1
                                    TypeQuantity(SimpleQuantity)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required when the product or service code does not convey the quantity provided.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    456. Claim.item.detail.subDetail.unitPrice
                                    Definition

                                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                    ShortFee, charge or cost per item
                                    Control0..1
                                    TypeMoney
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The amount charged to the patient by the provider for a single unit.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    458. Claim.item.detail.subDetail.factor
                                    Definition

                                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                    ShortPrice scaling factor
                                    Comments

                                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                    Control0..1
                                    Typedecimal
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    460. Claim.item.detail.subDetail.net
                                    Definition

                                    The quantity times the unit price for an additional service or product or charge.

                                    ShortTotal item cost
                                    Comments

                                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                    Control0..1
                                    TypeMoney
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Provides the total amount claimed for the group (if a grouper) or the line item.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    462. Claim.item.detail.subDetail.udi
                                    Definition

                                    Unique Device Identifiers associated with this line item.

                                    ShortUnique device identifier
                                    Control0..*
                                    TypeReference(Device)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    The UDI code allows the insurer to obtain device level information on the product supplied.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    464. Claim.total
                                    Definition

                                    The total value of the all the items in the claim.

                                    ShortTotal claim cost
                                    Control0..1
                                    TypeMoney
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Used for control total purposes.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))