Données socles des Entrepôts de Données de Santé Hospitalier
0.1.0 - ci-build FRA

Données socles des Entrepôts de Données de Santé Hospitalier - version de développement local (intégration continue v0.1.0) construite par les outils de publication FHIR (HL7® FHIR® Standard). Voir le répertoire des versions publiées

## Resource Profile: EdshClaimPmsi - Detailed Descriptions

Draft as of 2026-05-28

Definitions for the edsh-claim-pmsi resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

Des conseils sur l'interprétation du contenu de ce tableau peuvent être trouvésici

0. Claim
Définition | A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.
Court | Claim, Pre-determination or Pre-authorization
Commentaires | The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.
Contrôle | 0..*
Est modificateur | false
Résumé | false
Noms alternatifs | Adjudication Request, Preauthorization Request, Predetermination Request
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Claim.implicitRules
Définition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Court | A set of rules under which this content was created
Commentaires | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Contrôle | 0..1
Type | uri
Est modificateur | true parce que This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Claim.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Résumé | false
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. Claim.status
Définition | The status of the resource instance.
Court | active | cancelled | draft | entered-in-error
Commentaires | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Contrôle | 1..1
Binding | Les codes DOIVENT (SHALL) être pris de FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 (required to `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` ) A code specifying the state of the resource instance.
Type | code
Est modificateur | true parce que This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Claim.type
Définition | The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
Court | Champ du PMSI concerné.Category or discipline
Commentaires | The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.
Contrôle | 1..1
Binding | Les codes DOIVENT (SHALL) être pris de Sauf si inapproprié, ces codes DOIVENT (SHALL) être pris de ValueSet des type fr des claims http://hl7.org/fhir/ValueSet/claim-type|4.0.1 (required to `https://aphp.github.io/IG-FHIR-EDSH-SOCLE-COMMUN/ValueSet/fr-claim-type-vs` )
Type | CodeableConcept
Est modificateur | false
Résumé | true
Exigences | Claim type determine the general sets of business rules applied for information requirements and adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Claim.use
Définition | A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
Court | claim | preauthorization | predetermination
Contrôle | 1..1
Binding | Les codes DOIVENT (SHALL) être pris de Use http://hl7.org/fhir/ValueSet/claim-use|4.0.1 (required to `http://hl7.org/fhir/ValueSet/claim-use|4.0.1` ) The purpose of the Claim: predetermination, preauthorization, claim.
Type | code
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | This element is required to understand the nature of the request for adjudication.
Valeur de motif | `claim`
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Claim.patient
Définition | The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
Court | The recipient of the products and services
Contrôle | 1..1
Type | Reference(Patient, Patient)
Est modificateur | false
Résumé | true
Exigences | The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. Claim.created
Définition | The date this resource was created.
Court | Resource creation date
Commentaires | This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.
Contrôle | 1..1
Type | dateTime
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | Need to record a timestamp for use by both the recipient and the issuer.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. Claim.provider
Définition | The provider which is responsible for the claim, predetermination or preauthorization.
Court | Entité juridique émettriceParty responsible for the claim
Commentaires | Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.
Contrôle | 1..1
Type | Reference(Practitioner, PractitionerRole, Organization)
Est modificateur | false
Résumé | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. Claim.priority
Définition | The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
Court | Desired processing ugency
Commentaires | If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.
Contrôle | 1..1
Binding | Pour des exemples de codes, voir ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority|4.0.1 (example to `http://hl7.org/fhir/ValueSet/process-priority|4.0.1` ) The timeliness with which processing is required: stat, normal, deferred.
Type | CodeableConcept
Est modificateur | false
Résumé | true
Exigences | The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.
Valeur de motif | `{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" }] }`
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. Claim.insurance
Définition | Financial instruments for reimbursement for the health care products and services specified on the claim.
Court | Patient insurance information
Commentaires | All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
Contrôle | 1..*
Type | BackboneElement
Est modificateur | false
Résumé | true
Exigences | At least one insurer is required for a claim to be a claim.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. Claim.insurance.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
24. Claim.insurance.sequence
Définition | A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
Court | Insurance instance identifier
Contrôle | 1..1
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | To maintain order of the coverages.
Valeur de motif | `1`
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Claim.insurance.focal
Définition | A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
Court | Coverage to be used for adjudication
Commentaires | A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.
Contrôle | 1..1
Type | boolean
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | To identify which coverage in the list is being used to adjudicate this claim.
Valeur de motif | `true`
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. Claim.insurance.coverage
Définition | Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
Court | Insurance information
Contrôle | 1..1
Type | Reference(Coverage)
Est modificateur | false
Résumé | true
Exigences | Required to allow the adjudicator to locate the correct policy and history within their information system.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Claim.insurance.coverage.display
Définition | Plain text narrative that identifies the resource in addition to the resource reference.
Court | Text alternative for the resource
Commentaires | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Contrôle | 10..1
Type | string
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Valeur de motif | `Assurance Maladie`
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

Des conseils sur l'interprétation du contenu de ce tableau peuvent être trouvésici

0. Claim
2. Claim.type
Court | Champ du PMSI concerné.
Binding | Les codes DOIVENT (SHALL) être pris de ValueSet des type fr des claims (required to `https://aphp.github.io/IG-FHIR-EDSH-SOCLE-COMMUN/ValueSet/fr-claim-type-vs` )
4. Claim.use
Valeur de motif | `claim`
6. Claim.patient
Type | Reference(Patient)
8. Claim.provider
Court | Entité juridique émettrice
10. Claim.priority
Valeur de motif | `{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" }] }`
12. Claim.insurance
14. Claim.insurance.sequence
Valeur de motif | `1`
16. Claim.insurance.focal
Valeur de motif | `true`
18. Claim.insurance.coverage
20. Claim.insurance.coverage.display
Contrôle | 1..?
Valeur de motif | `Assurance Maladie`

Des conseils sur l'interprétation du contenu de ce tableau peuvent être trouvésici

0. Claim
Définition | A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.
Court | Claim, Pre-determination or Pre-authorization
Commentaires | The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.
Contrôle | 0..*
Est modificateur | false
Résumé | false
Noms alternatifs | Adjudication Request, Preauthorization Request, Predetermination Request
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (`contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`)
2. Claim.id
Définition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Court | Logical id of this artifact
Commentaires | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Contrôle | 0..1
Type | id
Est modificateur | false
Résumé | true
4. Claim.meta
Définition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Court | Metadata about the resource
Contrôle | 0..1
Type | Meta
Est modificateur | false
Résumé | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. Claim.implicitRules
Définition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Court | A set of rules under which this content was created
Commentaires | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Contrôle | 0..1
Type | uri
Est modificateur | true parce que This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. Claim.language
Définition | The base language in which the resource is written.
Court | Language of the resource content
Commentaires | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Contrôle | 0..1
Binding | Les codes DEVRAIENT (SHOULD) être pris de CommonLanguages (preferred to `http://hl7.org/fhir/ValueSet/languages|4.0.1` ) A human language.
Bindings Additionnels | But
AllLanguages | Binding Max
Type | code
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. Claim.text
Définition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Court | Text summary of the resource, for human interpretation
Commentaires | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Contrôle | 0..1
Type | Narrative
Est modificateur | false
Résumé | false
Noms alternatifs | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. Claim.contained
Définition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Court | Contained, inline Resources
Commentaires | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Contrôle | 0..*
Type | Resource
Est modificateur | false
Résumé | false
Noms alternatifs | inline resources, anonymous resources, contained resources
14. Claim.extension
Définition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
16. Claim.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Résumé | false
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
18. Claim.identifier
Définition | A unique identifier assigned to this claim.
Court | Business Identifier for claim
Note | Ceci est un identifiant métier, pas un identifiant de ressource (voir discussion)
Contrôle | 0..*
Type | Identifier
Est modificateur | false
Résumé | false
Exigences | Allows claims to be distinguished and referenced.
Noms alternatifs | Claim Number
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
20. Claim.status
Définition | The status of the resource instance.
Court | active | cancelled | draft | entered-in-error
Commentaires | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Contrôle | 1..1
Binding | Les codes DOIVENT (SHALL) être pris de FinancialResourceStatusCodes (required to `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` ) A code specifying the state of the resource instance.
Type | code
Est modificateur | true parce que This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
22. Claim.type
Définition | The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
Court | Champ du PMSI concerné.
Commentaires | The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.
Contrôle | 1..1
Binding | Les codes DOIVENT (SHALL) être pris de ValueSet des type fr des claims (required to `https://aphp.github.io/IG-FHIR-EDSH-SOCLE-COMMUN/ValueSet/fr-claim-type-vs` )
Type | CodeableConcept
Est modificateur | false
Résumé | true
Exigences | Claim type determine the general sets of business rules applied for information requirements and adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
24. Claim.subType
Définition | A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
Court | More granular claim type
Commentaires | This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExampleClaimSubTypeCodes (example to `http://hl7.org/fhir/ValueSet/claim-subtype|4.0.1` ) A more granular claim typecode.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Some jurisdictions need a finer grained claim type for routing and adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. Claim.use
Définition | A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
Court | claim | preauthorization | predetermination
Contrôle | 1..1
Binding | Les codes DOIVENT (SHALL) être pris de Use (required to `http://hl7.org/fhir/ValueSet/claim-use|4.0.1` ) The purpose of the Claim: predetermination, preauthorization, claim.
Type | code
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | This element is required to understand the nature of the request for adjudication.
Valeur de motif | `claim`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
28. Claim.patient
Définition | The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
Court | The recipient of the products and services
Contrôle | 1..1
Type | Reference(Patient)
Est modificateur | false
Résumé | true
Exigences | The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
30. Claim.billablePeriod
Définition | The period for which charges are being submitted.
Court | Relevant time frame for the claim
Commentaires | Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.
Contrôle | 0..1
Type | Period
Est modificateur | false
Résumé | true
Exigences | A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
32. Claim.created
Définition | The date this resource was created.
Court | Resource creation date
Commentaires | This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.
Contrôle | 1..1
Type | dateTime
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | Need to record a timestamp for use by both the recipient and the issuer.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
34. Claim.enterer
Définition | Individual who created the claim, predetermination or preauthorization.
Court | Author of the claim
Contrôle | 0..1
Type | Reference(Practitioner, PractitionerRole)
Est modificateur | false
Résumé | false
Exigences | Some jurisdictions require the contact information for personnel completing claims.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. Claim.insurer
Définition | The Insurer who is target of the request.
Court | Target
Contrôle | 0..1
Type | Reference(Organization)
Est modificateur | false
Résumé | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
38. Claim.provider
Définition | The provider which is responsible for the claim, predetermination or preauthorization.
Court | Entité juridique émettrice
Commentaires | Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.
Contrôle | 1..1
Type | Reference(Practitioner, PractitionerRole, Organization)
Est modificateur | false
Résumé | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
40. Claim.priority
Définition | The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
Court | Desired processing ugency
Commentaires | If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.
Contrôle | 1..1
Binding | Pour des exemples de codes, voir ProcessPriorityCodes (example to `http://hl7.org/fhir/ValueSet/process-priority|4.0.1` ) The timeliness with which processing is required: stat, normal, deferred.
Type | CodeableConcept
Est modificateur | false
Résumé | true
Exigences | The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.
Valeur de motif | `{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" }] }`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. Claim.fundsReserve
Définition | A code to indicate whether and for whom funds are to be reserved for future claims.
Court | For whom to reserve funds
Commentaires | This field is only used for preauthorizations.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir Funds Reservation Codes (example to `http://hl7.org/fhir/ValueSet/fundsreserve|4.0.1` ) For whom funds are to be reserved: (Patient, Provider, None).
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.
Noms alternatifs | Fund pre-allocation
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
44. Claim.related
Définition | Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
Court | Prior or corollary claims
Commentaires | For example, for the original treatment and follow-up exams.
Contrôle | 0..*
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | For workplace or other accidents it is common to relate separate claims arising from the same event.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
46. Claim.related.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
48. Claim.related.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
50. Claim.related.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
52. Claim.related.claim
Définition | Reference to a related claim.
Court | Reference to the related claim
Contrôle | 0..1
Type | Reference(Claim)
Est modificateur | false
Résumé | false
Exigences | For workplace or other accidents it is common to relate separate claims arising from the same event.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
54. Claim.related.relationship
Définition | A code to convey how the claims are related.
Court | How the reference claim is related
Commentaires | For example, prior claim or umbrella.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExampleRelatedClaimRelationshipCodes (example to `http://hl7.org/fhir/ValueSet/related-claim-relationship|4.0.1` ) Relationship of this claim to a related Claim.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Some insurers need a declaration of the type of relationship.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
56. Claim.related.reference
Définition | An alternate organizational reference to the case or file to which this particular claim pertains.
Court | File or case reference
Commentaires | For example, Property/Casualty insurer claim # or Workers Compensation case # .
Contrôle | 0..1
Type | Identifier
Est modificateur | false
Résumé | false
Exigences | In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. Claim.prescription
Définition | Prescription to support the dispensing of pharmacy, device or vision products.
Court | Prescription authorizing services and products
Contrôle | 0..1
Type | Reference(DeviceRequest, MedicationRequest, VisionPrescription)
Est modificateur | false
Résumé | false
Exigences | Required to authorize the dispensing of controlled substances and devices.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
60. Claim.originalPrescription
Définition | Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
Court | Original prescription if superseded by fulfiller
Commentaires | For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
Contrôle | 0..1
Type | Reference(DeviceRequest, MedicationRequest, VisionPrescription)
Est modificateur | false
Résumé | false
Exigences | Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
62. Claim.payee
Définition | The party to be reimbursed for cost of the products and services according to the terms of the policy.
Court | Recipient of benefits payable
Commentaires | Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead.
Contrôle | 0..1
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
64. Claim.payee.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
66. Claim.payee.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
68. Claim.payee.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
70. Claim.payee.type
Définition | Type of Party to be reimbursed: subscriber, provider, other.
Court | Category of recipient
Contrôle | 1..1
Binding | Pour des exemples de codes, voir Claim Payee Type Codes (example to `http://hl7.org/fhir/ValueSet/payeetype|4.0.1` ) A code for the party to be reimbursed.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
72. Claim.payee.party
Définition | Reference to the individual or organization to whom any payment will be made.
Court | Recipient reference
Commentaires | Not required if the payee is 'subscriber' or 'provider'.
Contrôle | 0..1
Type | Reference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson)
Est modificateur | false
Résumé | false
Exigences | Need to provide demographics if the payee is not 'subscriber' nor 'provider'.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
74. Claim.referral
Définition | A reference to a referral resource.
Court | Treatment referral
Commentaires | The referral resource which lists the date, practitioner, reason and other supporting information.
Contrôle | 0..1
Type | Reference(ServiceRequest)
Est modificateur | false
Résumé | false
Exigences | Some insurers require proof of referral to pay for services or to pay specialist rates for services.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
76. Claim.facility
Définition | Facility where the services were provided.
Court | Servicing facility
Contrôle | 0..1
Type | Reference(Location)
Est modificateur | false
Résumé | false
Exigences | Insurance adjudication can be dependant on where services were delivered.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
78. Claim.careTeam
Définition | The members of the team who provided the products and services.
Court | Members of the care team
Contrôle | 0..*
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | Common to identify the responsible and supporting practitioners.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
80. Claim.careTeam.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
82. Claim.careTeam.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
84. Claim.careTeam.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
86. Claim.careTeam.sequence
Définition | A number to uniquely identify care team entries.
Court | Order of care team
Contrôle | 1..1
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
88. Claim.careTeam.provider
Définition | Member of the team who provided the product or service.
Court | Practitioner or organization
Contrôle | 1..1
Type | Reference(Practitioner, PractitionerRole, Organization)
Est modificateur | false
Résumé | false
Exigences | Often a regulatory requirement to specify the responsible provider.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
90. Claim.careTeam.responsible
Définition | The party who is billing and/or responsible for the claimed products or services.
Court | Indicator of the lead practitioner
Commentaires | Responsible might not be required when there is only a single provider listed.
Contrôle | 0..1
Type | boolean
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | When multiple parties are present it is required to distinguish the lead or responsible individual.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
92. Claim.careTeam.role
Définition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
Court | Function within the team
Commentaires | Role might not be required when there is only a single provider listed.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ClaimCareTeamRoleCodes (example to `http://hl7.org/fhir/ValueSet/claim-careteamrole|4.0.1` ) The role codes for the care team members.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | When multiple parties are present it is required to distinguish the roles performed by each member.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
94. Claim.careTeam.qualification
Définition | The qualification of the practitioner which is applicable for this service.
Court | Practitioner credential or specialization
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExampleProviderQualificationCodes (example to `http://hl7.org/fhir/ValueSet/provider-qualification|4.0.1` ) Provider professional qualifications.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Need to specify which qualification a provider is delivering the product or service under.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
96. Claim.supportingInfo
Définition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
Court | Supporting information
Commentaires | Often there are multiple jurisdiction specific valuesets which are required.
Contrôle | 0..*
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | Typically these information codes are required to support the services rendered or the adjudication of the services rendered.
Noms alternatifs | Attachments Exception Codes Occurrence Codes Value codes
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
98. Claim.supportingInfo.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
100. Claim.supportingInfo.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
102. Claim.supportingInfo.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
104. Claim.supportingInfo.sequence
Définition | A number to uniquely identify supporting information entries.
Court | Information instance identifier
Contrôle | 1..1
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
106. Claim.supportingInfo.category
Définition | The general class of the information supplied: information; exception; accident, employment; onset, etc.
Court | Classification of the supplied information
Commentaires | This may contain a category for the local bill type codes.
Contrôle | 1..1
Binding | Pour des exemples de codes, voir ClaimInformationCategoryCodes (example to `http://hl7.org/fhir/ValueSet/claim-informationcategory|4.0.1` ) The valuset used for additional information category codes.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Required to group or associate information items with common characteristics. For example: admission information or prior treatments.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
108. Claim.supportingInfo.code
Définition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
Court | Type of information
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExceptionCodes (example to `http://hl7.org/fhir/ValueSet/claim-exception|4.0.1` ) The valuset used for additional information codes.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Required to identify the kind of additional information.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
110. Claim.supportingInfo.timing[x]
Définition | The date when or period to which this information refers.
Court | When it occurred
Contrôle | 0..1
Type | Choix de : date, Period
Note [x] | VoirChoix de types de donnéespour plus d'informations sur l'utilisation de [x]
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
112. Claim.supportingInfo.value[x]
Définition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
Court | Data to be provided
Commentaires | Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.
Contrôle | 0..1
Type | Choix de : boolean, string, Quantity, Attachment, Reference(Resource)
Note [x] | VoirChoix de types de donnéespour plus d'informations sur l'utilisation de [x]
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | To convey the data content to be provided when the information is more than a simple code or period.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
114. Claim.supportingInfo.reason
Définition | Provides the reason in the situation where a reason code is required in addition to the content.
Court | Explanation for the information
Commentaires | For example: the reason for the additional stay, or why a tooth is missing.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir MissingToothReasonCodes (example to `http://hl7.org/fhir/ValueSet/missing-tooth-reason|4.0.1` ) Reason codes for the missing teeth.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Needed when the supporting information has both a date and amount/value and requires explanation.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
116. Claim.diagnosis
Définition | Information about diagnoses relevant to the claim items.
Court | Pertinent diagnosis information
Contrôle | 0..*
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | Required for the adjudication by provided context for the services and product listed.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
118. Claim.diagnosis.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
120. Claim.diagnosis.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
122. Claim.diagnosis.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
124. Claim.diagnosis.sequence
Définition | A number to uniquely identify diagnosis entries.
Court | Diagnosis instance identifier
Commentaires | Diagnosis are presented in list order to their expected importance: primary, secondary, etc.
Contrôle | 1..1
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
126. Claim.diagnosis.diagnosis[x]
Définition | The nature of illness or problem in a coded form or as a reference to an external defined Condition.
Court | Nature of illness or problem
Contrôle | 1..1
Binding | Pour des exemples de codes, voir ICD-10Codes (example to `http://hl7.org/fhir/ValueSet/icd-10|4.0.1` ) Example ICD10 Diagnostic codes.
Type | Choix de : CodeableConcept, Reference(Condition)
Note [x] | VoirChoix de types de donnéespour plus d'informations sur l'utilisation de [x]
Est modificateur | false
Résumé | false
Exigences | Provides health context for the evaluation of the products and/or services.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
128. Claim.diagnosis.type
Définition | When the condition was observed or the relative ranking.
Court | Timing or nature of the diagnosis
Commentaires | For example: admitting, primary, secondary, discharge.
Contrôle | 0..*
Binding | Pour des exemples de codes, voir ExampleDiagnosisTypeCodes (example to `http://hl7.org/fhir/ValueSet/ex-diagnosistype|4.0.1` ) The type of the diagnosis: admitting, principal, discharge.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Often required to capture a particular diagnosis, for example: primary or discharge.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
130. Claim.diagnosis.onAdmission
Définition | Indication of whether the diagnosis was present on admission to a facility.
Court | Present on admission
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExampleDiagnosisOnAdmissionCodes (example to `http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission|4.0.1` ) Present on admission.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Many systems need to understand for adjudication if the diagnosis was present a time of admission.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
132. Claim.diagnosis.packageCode
Définition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.
Court | Package billing code
Commentaires | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExampleDiagnosisRelatedGroupCodes (example to `http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup|4.0.1` ) The DRG codes associated with the diagnosis.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
134. Claim.procedure
Définition | Procedures performed on the patient relevant to the billing items with the claim.
Court | Clinical procedures performed
Contrôle | 0..*
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
136. Claim.procedure.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
138. Claim.procedure.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
140. Claim.procedure.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
142. Claim.procedure.sequence
Définition | A number to uniquely identify procedure entries.
Court | Procedure instance identifier
Contrôle | 1..1
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Necessary to provide a mechanism to link to claim details.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
144. Claim.procedure.type
Définition | When the condition was observed or the relative ranking.
Court | Category of Procedure
Commentaires | For example: primary, secondary.
Contrôle | 0..*
Binding | Pour des exemples de codes, voir ExampleProcedureTypeCodes (example to `http://hl7.org/fhir/ValueSet/ex-procedure-type|4.0.1` ) Example procedure type codes.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Often required to capture a particular diagnosis, for example: primary or discharge.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
146. Claim.procedure.date
Définition | Date and optionally time the procedure was performed.
Court | When the procedure was performed
Contrôle | 0..1
Type | dateTime
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Required for auditing purposes.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
148. Claim.procedure.procedure[x]
Définition | The code or reference to a Procedure resource which identifies the clinical intervention performed.
Court | Specific clinical procedure
Contrôle | 1..1
Binding | Pour des exemples de codes, voir ICD-10ProcedureCodes (example to `http://hl7.org/fhir/ValueSet/icd-10-procedures|4.0.1` ) Example ICD10 Procedure codes.
Type | Choix de : CodeableConcept, Reference(Procedure)
Note [x] | VoirChoix de types de donnéespour plus d'informations sur l'utilisation de [x]
Est modificateur | false
Résumé | false
Exigences | This identifies the actual clinical procedure.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
150. Claim.procedure.udi
Définition | Unique Device Identifiers associated with this line item.
Court | Unique device identifier
Contrôle | 0..*
Type | Reference(Device)
Est modificateur | false
Résumé | false
Exigences | The UDI code allows the insurer to obtain device level information on the product supplied.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
152. Claim.insurance
Définition | Financial instruments for reimbursement for the health care products and services specified on the claim.
Court | Patient insurance information
Commentaires | All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
Contrôle | 1..*
Type | BackboneElement
Est modificateur | false
Résumé | true
Exigences | At least one insurer is required for a claim to be a claim.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
154. Claim.insurance.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
156. Claim.insurance.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
158. Claim.insurance.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
160. Claim.insurance.sequence
Définition | A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
Court | Insurance instance identifier
Contrôle | 1..1
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | To maintain order of the coverages.
Valeur de motif | `1`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
162. Claim.insurance.focal
Définition | A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
Court | Coverage to be used for adjudication
Commentaires | A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.
Contrôle | 1..1
Type | boolean
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Exigences | To identify which coverage in the list is being used to adjudicate this claim.
Valeur de motif | `true`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
164. Claim.insurance.identifier
Définition | The business identifier to be used when the claim is sent for adjudication against this insurance policy.
Court | Pre-assigned Claim number
Commentaires | Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'.
Note | Ceci est un identifiant métier, pas un identifiant de ressource (voir discussion)
Contrôle | 0..1
Type | Identifier
Est modificateur | false
Résumé | false
Exigences | This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
166. Claim.insurance.coverage
Définition | Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
Court | Insurance information
Contrôle | 1..1
Type | Reference(Coverage)
Est modificateur | false
Résumé | true
Exigences | Required to allow the adjudicator to locate the correct policy and history within their information system.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
168. Claim.insurance.coverage.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
170. Claim.insurance.coverage.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | Cet élément introduit un ensemble de slices sur `Claim.insurance.coverage.extension`. Les slices sontNon ordonné et Open, et peut être différencié en utilisant les discriminateurs suivants : value @ url
172. Claim.insurance.coverage.reference
Définition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Court | Literal reference, Relative, internal or absolute URL
Commentaires | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Contrôle | 0..1 Cet élément est affecté par les invariants suivants : ref-1
Type | string
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
174. Claim.insurance.coverage.type
Définition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Court | Type the reference refers to (e.g. "Patient")
Commentaires | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Contrôle | 0..1
Binding | Sauf si inapproprié, ces codes DOIVENT (SHALL) être pris de ResourceType (extensible to `http://hl7.org/fhir/ValueSet/resource-types|4.0.1` ) Aa resource (or, for logical models, the URI of the logical model).
Type | uri
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
176. Claim.insurance.coverage.identifier
Définition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Court | Logical reference, when literal reference is not known
Commentaires | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | Ceci est un identifiant métier, pas un identifiant de ressource (voir discussion)
Contrôle | 0..1
Type | Identifier
Est modificateur | false
Résumé | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
178. Claim.insurance.coverage.display
Définition | Plain text narrative that identifies the resource in addition to the resource reference.
Court | Text alternative for the resource
Commentaires | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Contrôle | 1..1
Type | string
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | true
Valeur de motif | `Assurance Maladie`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
180. Claim.insurance.businessArrangement
Définition | A business agreement number established between the provider and the insurer for special business processing purposes.
Court | Additional provider contract number
Contrôle | 0..1
Type | string
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
182. Claim.insurance.preAuthRef
Définition | Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
Court | Prior authorization reference number
Commentaires | This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.
Contrôle | 0..*
Type | string
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
184. Claim.insurance.claimResponse
Définition | The result of the adjudication of the line items for the Coverage specified in this insurance.
Court | Adjudication results
Commentaires | Must not be specified when 'focal=true' for this insurance.
Contrôle | 0..1
Type | Reference(ClaimResponse)
Est modificateur | false
Résumé | false
Exigences | An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
186. Claim.accident
Définition | Details of an accident which resulted in injuries which required the products and services listed in the claim.
Court | Details of the event
Contrôle | 0..1
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
188. Claim.accident.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
190. Claim.accident.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
192. Claim.accident.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
194. Claim.accident.date
Définition | Date of an accident event related to the products and services contained in the claim.
Court | When the incident occurred
Commentaires | The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.
Contrôle | 1..1
Type | date
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Required for audit purposes and adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
196. Claim.accident.type
Définition | The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.
Court | The nature of the accident
Contrôle | 0..1
Binding | Sauf si inapproprié, ces codes DOIVENT (SHALL) être pris de V3 Value SetActIncidentCode (extensible to `http://terminology.hl7.org/ValueSet/v3-ActIncidentCode` ) Type of accident: work place, auto, etc.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Coverage may be dependant on the type of accident.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
198. Claim.accident.location[x]
Définition | The physical location of the accident event.
Court | Where the event occurred
Contrôle | 0..1
Type | Choix de : Address, Reference(Location)
Note [x] | VoirChoix de types de donnéespour plus d'informations sur l'utilisation de [x]
Est modificateur | false
Résumé | false
Exigences | Required for audit purposes and determination of applicable insurance liability.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
200. Claim.item
Définition | A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
Court | Product or service provided
Contrôle | 0..*
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | The items to be processed for adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
202. Claim.item.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
204. Claim.item.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
206. Claim.item.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
208. Claim.item.sequence
Définition | A number to uniquely identify item entries.
Court | Item instance identifier
Contrôle | 1..1
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
210. Claim.item.careTeamSequence
Définition | CareTeam members related to this service or product.
Court | Applicable careTeam members
Contrôle | 0..*
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Need to identify the individuals and their roles in the provision of the product or service.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
212. Claim.item.diagnosisSequence
Définition | Diagnosis applicable for this service or product.
Court | Applicable diagnoses
Contrôle | 0..*
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Need to related the product or service to the associated diagnoses.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
214. Claim.item.procedureSequence
Définition | Procedures applicable for this service or product.
Court | Applicable procedures
Contrôle | 0..*
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Need to provide any listed specific procedures to support the product or service being claimed.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
216. Claim.item.informationSequence
Définition | Exceptions, special conditions and supporting information applicable for this service or product.
Court | Applicable exception and supporting information
Contrôle | 0..*
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Need to reference the supporting information items that relate directly to this product or service.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
218. Claim.item.revenue
Définition | The type of revenue or cost center providing the product and/or service.
Court | Revenue or cost center code
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExampleRevenueCenterCodes (example to `http://hl7.org/fhir/ValueSet/ex-revenue-center|4.0.1` ) Codes for the revenue or cost centers supplying the service and/or products.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Needed in the processing of institutional claims.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
220. Claim.item.category
Définition | Code to identify the general type of benefits under which products and services are provided.
Court | Benefit classification
Commentaires | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir BenefitCategoryCodes (example to `http://hl7.org/fhir/ValueSet/ex-benefitcategory|4.0.1` ) Benefit categories such as: oral-basic, major, glasses.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
222. Claim.item.productOrService
Définition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
Court | Billing, service, product, or drug code
Commentaires | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
Contrôle | 1..1
Binding | Pour des exemples de codes, voir USCLSCodes (example to `http://hl7.org/fhir/ValueSet/service-uscls|4.0.1` ) Allowable service and product codes.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Necessary to state what was provided or done.
Noms alternatifs | Drug Code, Bill Code, Service Code
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
224. Claim.item.modifier
Définition | Item typification or modifiers codes to convey additional context for the product or service.
Court | Product or service billing modifiers
Commentaires | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
Contrôle | 0..*
Binding | Pour des exemples de codes, voir ModifierTypeCodes (example to `http://hl7.org/fhir/ValueSet/claim-modifiers|4.0.1` ) Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | To support inclusion of the item for adjudication or to charge an elevated fee.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
226. Claim.item.programCode
Définition | Identifies the program under which this may be recovered.
Court | Program the product or service is provided under
Commentaires | For example: Neonatal program, child dental program or drug users recovery program.
Contrôle | 0..*
Binding | Pour des exemples de codes, voir ExampleProgramReasonCodes (example to `http://hl7.org/fhir/ValueSet/ex-program-code|4.0.1` ) Program specific reason codes.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
228. Claim.item.serviced[x]
Définition | The date or dates when the service or product was supplied, performed or completed.
Court | Date or dates of service or product delivery
Contrôle | 0..1
Type | Choix de : date, Period
Note [x] | VoirChoix de types de donnéespour plus d'informations sur l'utilisation de [x]
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Needed to determine whether the service or product was provided during the term of the insurance coverage.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
230. Claim.item.location[x]
Définition | Where the product or service was provided.
Court | Place of service or where product was supplied
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExampleServicePlaceCodes (example to `http://hl7.org/fhir/ValueSet/service-place|4.0.1` ) Place of service: pharmacy, school, prison, etc.
Type | Choix de : CodeableConcept, Address, Reference(Location)
Note [x] | VoirChoix de types de donnéespour plus d'informations sur l'utilisation de [x]
Est modificateur | false
Résumé | false
Exigences | The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
232. Claim.item.quantity
Définition | The number of repetitions of a service or product.
Court | Count of products or services
Contrôle | 0..1
Type | Quantity(SimpleQuantity)
Est modificateur | false
Résumé | false
Exigences | Required when the product or service code does not convey the quantity provided.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
234. Claim.item.unitPrice
Définition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
Court | Fee, charge or cost per item
Contrôle | 0..1
Type | Money
Est modificateur | false
Résumé | false
Exigences | The amount charged to the patient by the provider for a single unit.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
236. Claim.item.factor
Définition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
Court | Price scaling factor
Commentaires | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
Contrôle | 0..1
Type | decimal
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
238. Claim.item.net
Définition | The quantity times the unit price for an additional service or product or charge.
Court | Total item cost
Commentaires | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
Contrôle | 0..1
Type | Money
Est modificateur | false
Résumé | false
Exigences | Provides the total amount claimed for the group (if a grouper) or the line item.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
240. Claim.item.udi
Définition | Unique Device Identifiers associated with this line item.
Court | Unique device identifier
Contrôle | 0..*
Type | Reference(Device)
Est modificateur | false
Résumé | false
Exigences | The UDI code allows the insurer to obtain device level information on the product supplied.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
242. Claim.item.bodySite
Définition | Physical service site on the patient (limb, tooth, etc.).
Court | Anatomical location
Commentaires | For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir OralSiteCodes (example to `http://hl7.org/fhir/ValueSet/tooth|4.0.1` ) The code for the teeth, quadrant, sextant and arch.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Allows insurer to validate specific procedures.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
244. Claim.item.subSite
Définition | A region or surface of the bodySite, e.g. limb region or tooth surface(s).
Court | Anatomical sub-location
Contrôle | 0..*
Binding | Pour des exemples de codes, voir SurfaceCodes (example to `http://hl7.org/fhir/ValueSet/surface|4.0.1` ) The code for the tooth surface and surface combinations.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Allows insurer to validate specific procedures.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
246. Claim.item.encounter
Définition | The Encounters during which this Claim was created or to which the creation of this record is tightly associated.
Court | Encounters related to this billed item
Commentaires | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
Contrôle | 0..*
Type | Reference(Encounter)
Est modificateur | false
Résumé | false
Exigences | Used in some jurisdictions to link clinical events to claim items.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
248. Claim.item.detail
Définition | A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
Court | Product or service provided
Contrôle | 0..*
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | The items to be processed for adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
250. Claim.item.detail.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
252. Claim.item.detail.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
254. Claim.item.detail.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
256. Claim.item.detail.sequence
Définition | A number to uniquely identify item entries.
Court | Item instance identifier
Contrôle | 1..1
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
258. Claim.item.detail.revenue
Définition | The type of revenue or cost center providing the product and/or service.
Court | Revenue or cost center code
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExampleRevenueCenterCodes (example to `http://hl7.org/fhir/ValueSet/ex-revenue-center|4.0.1` ) Codes for the revenue or cost centers supplying the service and/or products.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Needed in the processing of institutional claims.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
260. Claim.item.detail.category
Définition | Code to identify the general type of benefits under which products and services are provided.
Court | Benefit classification
Commentaires | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir BenefitCategoryCodes (example to `http://hl7.org/fhir/ValueSet/ex-benefitcategory|4.0.1` ) Benefit categories such as: oral-basic, major, glasses.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
262. Claim.item.detail.productOrService
Définition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
Court | Billing, service, product, or drug code
Commentaires | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
Contrôle | 1..1
Binding | Pour des exemples de codes, voir USCLSCodes (example to `http://hl7.org/fhir/ValueSet/service-uscls|4.0.1` ) Allowable service and product codes.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Necessary to state what was provided or done.
Noms alternatifs | Drug Code, Bill Code, Service Code
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
264. Claim.item.detail.modifier
Définition | Item typification or modifiers codes to convey additional context for the product or service.
Court | Service/Product billing modifiers
Commentaires | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
Contrôle | 0..*
Binding | Pour des exemples de codes, voir ModifierTypeCodes (example to `http://hl7.org/fhir/ValueSet/claim-modifiers|4.0.1` ) Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | To support inclusion of the item for adjudication or to charge an elevated fee.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
266. Claim.item.detail.programCode
Définition | Identifies the program under which this may be recovered.
Court | Program the product or service is provided under
Commentaires | For example: Neonatal program, child dental program or drug users recovery program.
Contrôle | 0..*
Binding | Pour des exemples de codes, voir ExampleProgramReasonCodes (example to `http://hl7.org/fhir/ValueSet/ex-program-code|4.0.1` ) Program specific reason codes.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
268. Claim.item.detail.quantity
Définition | The number of repetitions of a service or product.
Court | Count of products or services
Contrôle | 0..1
Type | Quantity(SimpleQuantity)
Est modificateur | false
Résumé | false
Exigences | Required when the product or service code does not convey the quantity provided.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
270. Claim.item.detail.unitPrice
Définition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
Court | Fee, charge or cost per item
Contrôle | 0..1
Type | Money
Est modificateur | false
Résumé | false
Exigences | The amount charged to the patient by the provider for a single unit.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
272. Claim.item.detail.factor
Définition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
Court | Price scaling factor
Commentaires | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
Contrôle | 0..1
Type | decimal
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
274. Claim.item.detail.net
Définition | The quantity times the unit price for an additional service or product or charge.
Court | Total item cost
Commentaires | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
Contrôle | 0..1
Type | Money
Est modificateur | false
Résumé | false
Exigences | Provides the total amount claimed for the group (if a grouper) or the line item.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
276. Claim.item.detail.udi
Définition | Unique Device Identifiers associated with this line item.
Court | Unique device identifier
Contrôle | 0..*
Type | Reference(Device)
Est modificateur | false
Résumé | false
Exigences | The UDI code allows the insurer to obtain device level information on the product supplied.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
278. Claim.item.detail.subDetail
Définition | A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
Court | Product or service provided
Contrôle | 0..*
Type | BackboneElement
Est modificateur | false
Résumé | false
Exigences | The items to be processed for adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
280. Claim.item.detail.subDetail.id
Définition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Court | Unique id for inter-element referencing
Contrôle | 0..1
Type | string
Est modificateur | false
Format XML | Dans le format XML, cette propriété est représentée comme attribut.
Résumé | false
282. Claim.item.detail.subDetail.extension
Définition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Court | Additional content defined by implementations
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | false
Résumé | false
Noms alternatifs | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
284. Claim.item.detail.subDetail.modifierExtension
Définition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Court | Extensions that cannot be ignored even if unrecognized
Commentaires | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Contrôle | 0..*
Type | Extension
Est modificateur | true parce que Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Résumé | true
Exigences | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Noms alternatifs | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
286. Claim.item.detail.subDetail.sequence
Définition | A number to uniquely identify item entries.
Court | Item instance identifier
Contrôle | 1..1
Type | positiveInt
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
288. Claim.item.detail.subDetail.revenue
Définition | The type of revenue or cost center providing the product and/or service.
Court | Revenue or cost center code
Contrôle | 0..1
Binding | Pour des exemples de codes, voir ExampleRevenueCenterCodes (example to `http://hl7.org/fhir/ValueSet/ex-revenue-center|4.0.1` ) Codes for the revenue or cost centers supplying the service and/or products.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Needed in the processing of institutional claims.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
290. Claim.item.detail.subDetail.category
Définition | Code to identify the general type of benefits under which products and services are provided.
Court | Benefit classification
Commentaires | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
Contrôle | 0..1
Binding | Pour des exemples de codes, voir BenefitCategoryCodes (example to `http://hl7.org/fhir/ValueSet/ex-benefitcategory|4.0.1` ) Benefit categories such as: oral-basic, major, glasses.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
292. Claim.item.detail.subDetail.productOrService
Définition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
Court | Billing, service, product, or drug code
Commentaires | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
Contrôle | 1..1
Binding | Pour des exemples de codes, voir USCLSCodes (example to `http://hl7.org/fhir/ValueSet/service-uscls|4.0.1` ) Allowable service and product codes.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Necessary to state what was provided or done.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
294. Claim.item.detail.subDetail.modifier
Définition | Item typification or modifiers codes to convey additional context for the product or service.
Court | Service/Product billing modifiers
Commentaires | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
Contrôle | 0..*
Binding | Pour des exemples de codes, voir ModifierTypeCodes (example to `http://hl7.org/fhir/ValueSet/claim-modifiers|4.0.1` ) Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | To support inclusion of the item for adjudication or to charge an elevated fee.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
296. Claim.item.detail.subDetail.programCode
Définition | Identifies the program under which this may be recovered.
Court | Program the product or service is provided under
Commentaires | For example: Neonatal program, child dental program or drug users recovery program.
Contrôle | 0..*
Binding | Pour des exemples de codes, voir ExampleProgramReasonCodes (example to `http://hl7.org/fhir/ValueSet/ex-program-code|4.0.1` ) Program specific reason codes.
Type | CodeableConcept
Est modificateur | false
Résumé | false
Exigences | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
298. Claim.item.detail.subDetail.quantity
Définition | The number of repetitions of a service or product.
Court | Count of products or services
Contrôle | 0..1
Type | Quantity(SimpleQuantity)
Est modificateur | false
Résumé | false
Exigences | Required when the product or service code does not convey the quantity provided.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
300. Claim.item.detail.subDetail.unitPrice
Définition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
Court | Fee, charge or cost per item
Contrôle | 0..1
Type | Money
Est modificateur | false
Résumé | false
Exigences | The amount charged to the patient by the provider for a single unit.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
302. Claim.item.detail.subDetail.factor
Définition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
Court | Price scaling factor
Commentaires | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
Contrôle | 0..1
Type | decimal
Est modificateur | false
Valeur primitive | Cet élément primitif peut être présent, absent ou remplacé par une extension
Résumé | false
Exigences | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
304. Claim.item.detail.subDetail.net
Définition | The quantity times the unit price for an additional service or product or charge.
Court | Total item cost
Commentaires | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
Contrôle | 0..1
Type | Money
Est modificateur | false
Résumé | false
Exigences | Provides the total amount claimed for the group (if a grouper) or the line item.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
306. Claim.item.detail.subDetail.udi
Définition | Unique Device Identifiers associated with this line item.
Court | Unique device identifier
Contrôle | 0..*
Type | Reference(Device)
Est modificateur | false
Résumé | false
Exigences | The UDI code allows the insurer to obtain device level information on the product supplied.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
308. Claim.total
Définition | The total value of the all the items in the claim.
Court | Total claim cost
Contrôle | 0..1
Type | Money
Est modificateur | false
Résumé | false
Exigences | Used for control total purposes.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)