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: RSS du PMSI MCO

Official URL: https://interop.esante.gouv.fr/ig/fhir/eds/StructureDefinition/EDSClaimRSS Version: 0.1.0
Draft as of 2024-10-08 Computable Name: EDSClaimRSS

Profil pour les Résumés de Sortie Standardisé (RSS) du PMSI MCO.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from EDSClaimPMSIMCO

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* EDSClaimPMSIMCO Claim, Pre-determination or Pre-authorization
... billablePeriod S 0..1 Period Relevant time frame for the claim
.... start 0..1 dateTime date d'entrée dans la première unité médicale visitée
.... end 0..1 dateTime date de sortie de la dernière unité médicale visitée
... Slices for supportingInfo 2..* BackboneElement supportingInfo
Slice: Unordered, Open by value:code.coding.code, value:code.coding.system
.... supportingInfo:ModeIn S 1..1 BackboneElement Supporting information
..... category 1..1 CodeableConcept Classification of the supplied information
Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
..... code
...... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeInCode S 1..1 Coding Code defined by a terminology system
........ system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ code 1..1 code Symbol in syntax defined by the system
Fixed Value: 0
..... value[x] S 0..1 string valeur du mode d'entrée
.... supportingInfo:ModeOut S 1..1 BackboneElement Supporting information
..... category 1..1 CodeableConcept Classification of the supplied information
Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
..... code
...... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeOutCode S 1..1 Coding Code defined by a terminology system
........ system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ code 1..1 code Symbol in syntax defined by the system
Fixed Value: 1
..... value[x] S 0..1 string valeur du mode de sortie
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by value:type
.... diagnosis:dp S 1..1 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DP pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Fixed Value: As shown (Diagnostic Principal)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DP
.... diagnosis:dr S 0..1 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DR pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Fixed Value: As shown (Diagonstic Relié)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DR
.... diagnosis:da S 0..* BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DA pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Fixed Value: As shown (Diagnostic Associé Significatif)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DA
.... diagnosis:dad S 0..* BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 pour le PMSI (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Fixed Value: As shown (Diagnostic Associé Documentaire)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DAD
.... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: Listes des Actes CCAM pour le PMSI (required)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Claim.diagnosis:dp.diagnosis[x]requiredCIM10PMSIDP
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDP
from this IG
Claim.diagnosis:dr.diagnosis[x]requiredCIM10PMSIDR
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDR
from this IG
Claim.diagnosis:da.diagnosis[x]requiredCIM10PMSIDA
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDA
from this IG
Claim.diagnosis:dad.diagnosis[x]requiredCIM10PMSI (a valid code from CIM 10 PMSI)
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSI
from this IG
Claim.procedure.procedure[x]requiredCCAM
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CCAM
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* EDSClaimPMSIMCO Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimType
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PMSIMCO
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: claim
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
.... start ΣC 0..1 dateTime date d'entrée dans la première unité médicale visitée
.... end ΣC 0..1 dateTime date de sortie de la dernière unité médicale visitée
... created Σ 1..1 dateTime Resource creation date
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Entité juridique émettrice
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: normal
... Slices for supportingInfo 2..* BackboneElement supportingInfo
Slice: Unordered, Open by value:code.coding.code, value:code.coding.system
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... supportingInfo:ModeIn S 1..1 BackboneElement Supporting information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

...... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeInCode SΣ 1..1 Coding Code defined by a terminology system
........ system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 0
..... value[x] S 0..1 string valeur du mode d'entrée
.... supportingInfo:ModeOut S 1..1 BackboneElement Supporting information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

...... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeOutCode SΣ 1..1 Coding Code defined by a terminology system
........ system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 1
..... value[x] S 0..1 string valeur du mode de sortie
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by value:type
.... diagnosis:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
.... diagnosis:dp S 1..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DP pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Principal)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DP
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
.... diagnosis:dr S 0..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DR pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagonstic Relié)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DR
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
.... diagnosis:da S 0..* BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DA pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Associé Significatif)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DA
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
.... diagnosis:dad S 0..* BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 pour le PMSI (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Associé Documentaire)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DAD
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
... procedure S 0..* BackboneElement Clinical procedures performed
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: Listes des Actes CCAM pour le PMSI (required)
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(Coverage) Insurance information

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typerequiredPattern: PMSIMCO
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/FrClaimType
from this IG
Claim.userequiredPattern: claim
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityexamplePattern: normal
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeIn.categoryexampleFixed Value: RUM
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeIn.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:ModeOut.categoryexampleFixed Value: RUM
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeOut.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis:dp.diagnosis[x]requiredCIM10PMSIDP
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDP
from this IG
Claim.diagnosis:dp.typeexampleFixed Value: DP
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dr.diagnosis[x]requiredCIM10PMSIDR
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDR
from this IG
Claim.diagnosis:dr.typeexampleFixed Value: DR
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:da.diagnosis[x]requiredCIM10PMSIDA
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDA
from this IG
Claim.diagnosis:da.typeexampleFixed Value: DA
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dad.diagnosis[x]requiredCIM10PMSI (a valid code from CIM 10 PMSI)
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSI
from this IG
Claim.diagnosis:dad.typeexampleFixed Value: DAD
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.procedure.procedure[x]requiredCCAM
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CCAM
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* EDSClaimPMSIMCO Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for claim
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Champ du PMSI concerné.
Binding: ValueSet des type fr des claims (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimType
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PMSIMCO
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: claim
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... start ΣC 0..1 dateTime date d'entrée dans la première unité médicale visitée
.... end ΣC 0..1 dateTime date de sortie de la dernière unité médicale visitée
... created Σ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 Reference(Organization) Target
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Entité juridique émettrice
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.


Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: normal
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment referral
... facility 0..1 Reference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... Slices for supportingInfo 2..* BackboneElement supportingInfo
Slice: Unordered, Open by value:code.coding.code, value:code.coding.system
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:ModeIn S 1..1 BackboneElement Supporting information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeInCode SΣ 1..1 Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ version Σ 0..1 string Version of the system - if relevant
........ code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 0
........ display Σ 0..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] S 0..1 string valeur du mode d'entrée
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:ModeOut S 1..1 BackboneElement Supporting information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeOutCode SΣ 1..1 Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ version Σ 0..1 string Version of the system - if relevant
........ code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 1
........ display Σ 0..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] S 0..1 string valeur du mode de sortie
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by value:type
.... diagnosis:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
..... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:dp S 1..1 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DP pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Principal)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DP
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:dr S 0..1 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DR pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagonstic Relié)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DR
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:da S 0..* BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DA pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Associé Significatif)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DA
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:dad S 0..* BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 pour le PMSI (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Associé Documentaire)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DAD
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure S 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: Listes des Actes CCAM pour le PMSI (required)
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity 0..1 SimpleQuantity Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity 0..1 SimpleQuantity Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typerequiredPattern: PMSIMCO
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/FrClaimType
from this IG
Claim.subTypeexampleExampleClaimSubTypeCodes
http://hl7.org/fhir/ValueSet/claim-subtype
from the FHIR Standard
Claim.userequiredPattern: claim
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityexamplePattern: normal
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.fundsReserveexampleFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:ModeIn.categoryexampleFixed Value: RUM
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeIn.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:ModeIn.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:ModeOut.categoryexampleFixed Value: RUM
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeOut.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:ModeOut.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:dp.diagnosis[x]requiredCIM10PMSIDP
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDP
from this IG
Claim.diagnosis:dp.typeexampleFixed Value: DP
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dp.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:dp.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:dr.diagnosis[x]requiredCIM10PMSIDR
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDR
from this IG
Claim.diagnosis:dr.typeexampleFixed Value: DR
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dr.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:dr.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:da.diagnosis[x]requiredCIM10PMSIDA
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDA
from this IG
Claim.diagnosis:da.typeexampleFixed Value: DA
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:da.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:da.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:dad.diagnosis[x]requiredCIM10PMSI (a valid code from CIM 10 PMSI)
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSI
from this IG
Claim.diagnosis:dad.typeexampleFixed Value: DAD
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dad.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:dad.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.procedure.typeexampleExampleProcedureTypeCodes
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure.procedure[x]requiredCCAM
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CCAM
from this IG
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
from the FHIR Standard
Claim.item.bodySiteexampleOralSiteCodes
http://hl7.org/fhir/ValueSet/tooth
from the FHIR Standard
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from EDSClaimPMSIMCO

Summary

Mandatory: 5 elements(11 nested mandatory elements)
Must-Support: 13 elements
Fixed: 10 elements

Slices

This structure defines the following Slices:

  • The element 2 is sliced based on the values of Claim.supportingInfo
  • The element 2 is sliced based on the values of Claim.supportingInfo.code.coding
  • The element 1 is sliced based on the value of Claim.diagnosis

Differential View

This structure is derived from EDSClaimPMSIMCO

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* EDSClaimPMSIMCO Claim, Pre-determination or Pre-authorization
... billablePeriod S 0..1 Period Relevant time frame for the claim
.... start 0..1 dateTime date d'entrée dans la première unité médicale visitée
.... end 0..1 dateTime date de sortie de la dernière unité médicale visitée
... Slices for supportingInfo 2..* BackboneElement supportingInfo
Slice: Unordered, Open by value:code.coding.code, value:code.coding.system
.... supportingInfo:ModeIn S 1..1 BackboneElement Supporting information
..... category 1..1 CodeableConcept Classification of the supplied information
Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
..... code
...... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeInCode S 1..1 Coding Code defined by a terminology system
........ system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ code 1..1 code Symbol in syntax defined by the system
Fixed Value: 0
..... value[x] S 0..1 string valeur du mode d'entrée
.... supportingInfo:ModeOut S 1..1 BackboneElement Supporting information
..... category 1..1 CodeableConcept Classification of the supplied information
Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
..... code
...... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeOutCode S 1..1 Coding Code defined by a terminology system
........ system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ code 1..1 code Symbol in syntax defined by the system
Fixed Value: 1
..... value[x] S 0..1 string valeur du mode de sortie
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by value:type
.... diagnosis:dp S 1..1 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DP pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Fixed Value: As shown (Diagnostic Principal)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DP
.... diagnosis:dr S 0..1 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DR pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Fixed Value: As shown (Diagonstic Relié)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DR
.... diagnosis:da S 0..* BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DA pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Fixed Value: As shown (Diagnostic Associé Significatif)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DA
.... diagnosis:dad S 0..* BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 pour le PMSI (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Fixed Value: As shown (Diagnostic Associé Documentaire)
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DAD
.... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: Listes des Actes CCAM pour le PMSI (required)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Claim.diagnosis:dp.diagnosis[x]requiredCIM10PMSIDP
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDP
from this IG
Claim.diagnosis:dr.diagnosis[x]requiredCIM10PMSIDR
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDR
from this IG
Claim.diagnosis:da.diagnosis[x]requiredCIM10PMSIDA
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDA
from this IG
Claim.diagnosis:dad.diagnosis[x]requiredCIM10PMSI (a valid code from CIM 10 PMSI)
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSI
from this IG
Claim.procedure.procedure[x]requiredCCAM
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CCAM
from this IG

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* EDSClaimPMSIMCO Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimType
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PMSIMCO
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: claim
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
.... start ΣC 0..1 dateTime date d'entrée dans la première unité médicale visitée
.... end ΣC 0..1 dateTime date de sortie de la dernière unité médicale visitée
... created Σ 1..1 dateTime Resource creation date
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Entité juridique émettrice
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: normal
... Slices for supportingInfo 2..* BackboneElement supportingInfo
Slice: Unordered, Open by value:code.coding.code, value:code.coding.system
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... supportingInfo:ModeIn S 1..1 BackboneElement Supporting information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

...... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeInCode SΣ 1..1 Coding Code defined by a terminology system
........ system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 0
..... value[x] S 0..1 string valeur du mode d'entrée
.... supportingInfo:ModeOut S 1..1 BackboneElement Supporting information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

...... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeOutCode SΣ 1..1 Coding Code defined by a terminology system
........ system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 1
..... value[x] S 0..1 string valeur du mode de sortie
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by value:type
.... diagnosis:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
.... diagnosis:dp S 1..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DP pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Principal)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DP
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
.... diagnosis:dr S 0..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DR pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagonstic Relié)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DR
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
.... diagnosis:da S 0..* BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DA pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Associé Significatif)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DA
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
.... diagnosis:dad S 0..* BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 pour le PMSI (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Associé Documentaire)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DAD
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
... procedure S 0..* BackboneElement Clinical procedures performed
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: Listes des Actes CCAM pour le PMSI (required)
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(Coverage) Insurance information

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typerequiredPattern: PMSIMCO
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/FrClaimType
from this IG
Claim.userequiredPattern: claim
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityexamplePattern: normal
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeIn.categoryexampleFixed Value: RUM
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeIn.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:ModeOut.categoryexampleFixed Value: RUM
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeOut.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis:dp.diagnosis[x]requiredCIM10PMSIDP
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDP
from this IG
Claim.diagnosis:dp.typeexampleFixed Value: DP
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dr.diagnosis[x]requiredCIM10PMSIDR
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDR
from this IG
Claim.diagnosis:dr.typeexampleFixed Value: DR
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:da.diagnosis[x]requiredCIM10PMSIDA
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDA
from this IG
Claim.diagnosis:da.typeexampleFixed Value: DA
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dad.diagnosis[x]requiredCIM10PMSI (a valid code from CIM 10 PMSI)
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSI
from this IG
Claim.diagnosis:dad.typeexampleFixed Value: DAD
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.procedure.procedure[x]requiredCCAM
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CCAM
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* EDSClaimPMSIMCO Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for claim
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Champ du PMSI concerné.
Binding: ValueSet des type fr des claims (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimType
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PMSIMCO
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: claim
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod SΣ 0..1 Period Relevant time frame for the claim
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... start ΣC 0..1 dateTime date d'entrée dans la première unité médicale visitée
.... end ΣC 0..1 dateTime date de sortie de la dernière unité médicale visitée
... created Σ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 Reference(Organization) Target
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Entité juridique émettrice
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.


Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: normal
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment referral
... facility 0..1 Reference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... Slices for supportingInfo 2..* BackboneElement supportingInfo
Slice: Unordered, Open by value:code.coding.code, value:code.coding.system
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:ModeIn S 1..1 BackboneElement Supporting information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeInCode SΣ 1..1 Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ version Σ 0..1 string Version of the system - if relevant
........ code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 0
........ display Σ 0..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] S 0..1 string valeur du mode d'entrée
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

.... supportingInfo:ModeOut S 1..1 BackboneElement Supporting information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Information instance identifier
..... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.


Fixed Value: As shown (Information contextualisant un Claim de sous type RUM)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimSupInfoCategoryPMSIMCO
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: RUM
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:code, value:system
....... coding:ModeOutCode SΣ 1..1 Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system Σ 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/FrClaimMode
........ version Σ 0..1 string Version of the system - if relevant
........ code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: 1
........ display Σ 0..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] S 0..1 string valeur du mode de sortie
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by value:type
.... diagnosis:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
..... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:dp S 1..1 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DP pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Principal)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DP
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:dr S 0..1 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DR pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagonstic Relié)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DR
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:da S 0..* BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 acceptable en DA pour les PMSI MCO et HAD (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Associé Significatif)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DA
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:dad S 0..* BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: Liste des diagnostiques CIM-10 pour le PMSI (required)
..... type 1..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Fixed Value: As shown (Diagnostic Associé Documentaire)
...... id 0..0 string Unique id for inter-element referencing
...... extension 0..0 Extension Additional content defined by implementations
...... coding 1..1 Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..0 string Unique id for inter-element referencing
....... extension 0..0 Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: https://interop.esante.gouv.fr/ig/fhir/eds/CodeSystem/PMSIMCODiagType
....... version 0..0 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: DAD
....... display 0..0 string Representation defined by the system
....... userSelected 0..0 boolean If this coding was chosen directly by the user
...... text 0..0 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure S 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: Listes des Actes CCAM pour le PMSI (required)
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity 0..1 SimpleQuantity Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity 0..1 SimpleQuantity Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typerequiredPattern: PMSIMCO
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/FrClaimType
from this IG
Claim.subTypeexampleExampleClaimSubTypeCodes
http://hl7.org/fhir/ValueSet/claim-subtype
from the FHIR Standard
Claim.userequiredPattern: claim
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.priorityexamplePattern: normal
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.fundsReserveexampleFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.roleexampleClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:ModeIn.categoryexampleFixed Value: RUM
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeIn.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:ModeIn.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.supportingInfo:ModeOut.categoryexampleFixed Value: RUM
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo:ModeOut.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo:ModeOut.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typeexampleExampleDiagnosisTypeCodes
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:dp.diagnosis[x]requiredCIM10PMSIDP
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDP
from this IG
Claim.diagnosis:dp.typeexampleFixed Value: DP
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dp.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:dp.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:dr.diagnosis[x]requiredCIM10PMSIDR
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDR
from this IG
Claim.diagnosis:dr.typeexampleFixed Value: DR
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dr.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:dr.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:da.diagnosis[x]requiredCIM10PMSIDA
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSIDA
from this IG
Claim.diagnosis:da.typeexampleFixed Value: DA
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:da.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:da.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:dad.diagnosis[x]requiredCIM10PMSI (a valid code from CIM 10 PMSI)
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CIM10PMSI
from this IG
Claim.diagnosis:dad.typeexampleFixed Value: DAD
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:dad.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:dad.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.procedure.typeexampleExampleProcedureTypeCodes
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure.procedure[x]requiredCCAM
https://interop.esante.gouv.fr/ig/fhir/eds/ValueSet/CCAM
from this IG
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
from the FHIR Standard
Claim.item.bodySiteexampleOralSiteCodes
http://hl7.org/fhir/ValueSet/tooth
from the FHIR Standard
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from EDSClaimPMSIMCO

Summary

Mandatory: 5 elements(11 nested mandatory elements)
Must-Support: 13 elements
Fixed: 10 elements

Slices

This structure defines the following Slices:

  • The element 2 is sliced based on the values of Claim.supportingInfo
  • The element 2 is sliced based on the values of Claim.supportingInfo.code.coding
  • The element 1 is sliced based on the value of Claim.diagnosis

 

Other representations of profile: CSV, Excel, Schematron