Data Management with FHIR
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Data Management with FHIR - 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: Profil de Claim pour le PMSI ( Abstract )

Official URL: https://aphp.github.io/IG-fhir-dm/StructureDefinition/DMClaimPMSI Version: 0.1.0
Draft as of 2026-02-05 Computable Name: DMClaimPMSI

Profil abstrait pour les invariants dans les claims du PMSI.

Utilisations:

Vous pouvez également vérifier les usages dans le FHIR IG Statistics

Formal Views of Profile Content

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

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Claim 0..* Claim Ceci est un élément abstrait profile. Enfant profiles: DMClaimPMSIMCO
Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Motif requis: claim
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... created Σ 1..1 dateTime Resource creation date
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Entité juridique émettrice
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Motif requis: Au moins les éléments suivants
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Valeur fixe : (Complexe)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Valeur fixe : http://terminology.hl7.org/CodeSystem/processpriority
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Valeur fixe : normal
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
Motif requis: 1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
Motif requis: true
.... coverage Σ 1..1 Reference(Coverage) Insurance information
..... display Σ 1..1 string Text alternative for the resource
Motif requis: Assurance Maladie

doco Documentation pour ce format

Bindings terminologiques

Chemin Statut Usage Jeu de valeurs (ValueSet) Version Source
Claim.status Base required Financial Resource Status Codes 📍4.0.1 Std. FHIR
Claim.type Base required ValueSet des type fr des claims 📦0.1.0 cet IG
Claim.use Base required Use 📍4.0.1 Std. FHIR
Claim.priority Base example Process Priority Codes 📍4.0.1 Std. FHIR

Contraintes

Id Grade Chemin(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 bonne pratique Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **TOUS** les éléments All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **TOUTES** les extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Claim 0..* Claim Ceci est un élément abstrait profile. Enfant profiles: DMClaimPMSIMCO
Claim, Pre-determination or Pre-authorization
... type 1..1 CodeableConcept Champ du PMSI concerné.
Binding: ValueSet des type fr des claims (required)
... use 1..1 code claim | preauthorization | predetermination
Motif requis: claim
... patient 1..1 Reference(Patient) The recipient of the products and services
... priority 1..1 CodeableConcept Desired processing ugency
Motif requis: Au moins les éléments suivants
.... coding 1..* Coding Code defined by a terminology system
Valeur fixe : (Complexe)
..... system 1..1 uri Identity of the terminology system
Valeur fixe : http://terminology.hl7.org/CodeSystem/processpriority
..... code 1..1 code Symbol in syntax defined by the system
Valeur fixe : normal
... insurance
.... sequence 1..1 positiveInt Insurance instance identifier
Motif requis: 1
.... focal 1..1 boolean Coverage to be used for adjudication
Motif requis: true
.... coverage
..... display 1..1 string Text alternative for the resource
Motif requis: Assurance Maladie

doco Documentation pour ce format

Bindings terminologiques (différentiel)

Chemin Statut Usage Jeu de valeurs (ValueSet) Version Source
Claim.type Base required ValueSet des type fr des claims 📦0.1.0 cet IG
NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Claim 0..* Claim Ceci est un élément abstrait profile. Enfant profiles: DMClaimPMSIMCO
Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Bindings AdditionnelsBut
AllLanguages Binding Max
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for claim
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type Σ 1..1 CodeableConcept Champ du PMSI concerné.
Binding: ValueSet des type fr des claims (required)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Motif requis: claim
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created Σ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 Reference(Organization) Target
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Entité juridique émettrice
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Motif requis: Au moins les éléments suivants
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Valeur fixe : (Complexe)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Valeur fixe : http://terminology.hl7.org/CodeSystem/processpriority
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Valeur fixe : normal
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment referral
... facility 0..1 Reference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
.... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
Motif requis: 1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
Motif requis: true
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(Coverage) Insurance information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Non ordonné, Ouvert par value:url
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 1..1 string Text alternative for the resource
Motif requis: Assurance Maladie
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total 0..1 Money Total claim cost

doco Documentation pour ce format

Bindings terminologiques

Chemin Statut Usage Jeu de valeurs (ValueSet) Version Source
Claim.language Base preferred Common Languages 📍4.0.1 Std. FHIR
Claim.status Base required Financial Resource Status Codes 📍4.0.1 Std. FHIR
Claim.type Base required ValueSet des type fr des claims 📦0.1.0 cet IG
Claim.subType Base example Example Claim SubType Codes 📍4.0.1 Std. FHIR
Claim.use Base required Use 📍4.0.1 Std. FHIR
Claim.priority Base example Process Priority Codes 📍4.0.1 Std. FHIR
Claim.fundsReserve Base example FundsReserve 📍4.0.1 Std. FHIR
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 Std. FHIR
Claim.payee.type Base example PayeeType 📍4.0.1 Std. FHIR
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 Std. FHIR
Claim.careTeam.qualification Base example Example Provider Qualification Codes 📍4.0.1 Std. FHIR
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.0.1 Std. FHIR
Claim.supportingInfo.​code Base example Exception Codes 📍4.0.1 Std. FHIR
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.0.1 Std. FHIR
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 Std. FHIR
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.0.1 Std. FHIR
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 Std. FHIR
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 Std. FHIR
Claim.procedure.type Base example Example Procedure Type Codes 📍4.0.1 Std. FHIR
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 Std. FHIR
Claim.insurance.coverage.​type Base extensible ResourceType 📍4.0.1 Std. FHIR
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
Claim.item.revenue Base example Example Revenue Center Codes 📍4.0.1 Std. FHIR
Claim.item.category Base example Benefit Category Codes 📍4.0.1 Std. FHIR
Claim.item.productOrService Base example USCLS Codes 📍4.0.1 Std. FHIR
Claim.item.modifier Base example Modifier type Codes 📍4.0.1 Std. FHIR
Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 Std. FHIR
Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 Std. FHIR
Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 Std. FHIR
Claim.item.subSite Base example Surface Codes 📍4.0.1 Std. FHIR
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 Std. FHIR
Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 Std. FHIR
Claim.item.detail.productOrService Base example USCLS Codes 📍4.0.1 Std. FHIR
Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 Std. FHIR
Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍4.0.1 Std. FHIR

Contraintes

Id Grade Chemin(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 bonne pratique Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **TOUS** les éléments All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **TOUTES** les extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

Résumé

Obligatoire : 1 élément

Structures

Cette structure fait référence à ces autres structures:

Key Elements View

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Claim 0..* Claim Ceci est un élément abstrait profile. Enfant profiles: DMClaimPMSIMCO
Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Motif requis: claim
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... created Σ 1..1 dateTime Resource creation date
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Entité juridique émettrice
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Motif requis: Au moins les éléments suivants
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Valeur fixe : (Complexe)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Valeur fixe : http://terminology.hl7.org/CodeSystem/processpriority
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Valeur fixe : normal
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
Motif requis: 1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
Motif requis: true
.... coverage Σ 1..1 Reference(Coverage) Insurance information
..... display Σ 1..1 string Text alternative for the resource
Motif requis: Assurance Maladie

doco Documentation pour ce format

Bindings terminologiques

Chemin Statut Usage Jeu de valeurs (ValueSet) Version Source
Claim.status Base required Financial Resource Status Codes 📍4.0.1 Std. FHIR
Claim.type Base required ValueSet des type fr des claims 📦0.1.0 cet IG
Claim.use Base required Use 📍4.0.1 Std. FHIR
Claim.priority Base example Process Priority Codes 📍4.0.1 Std. FHIR

Contraintes

Id Grade Chemin(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 bonne pratique Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **TOUS** les éléments All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **TOUTES** les extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from Claim

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Claim 0..* Claim Ceci est un élément abstrait profile. Enfant profiles: DMClaimPMSIMCO
Claim, Pre-determination or Pre-authorization
... type 1..1 CodeableConcept Champ du PMSI concerné.
Binding: ValueSet des type fr des claims (required)
... use 1..1 code claim | preauthorization | predetermination
Motif requis: claim
... patient 1..1 Reference(Patient) The recipient of the products and services
... priority 1..1 CodeableConcept Desired processing ugency
Motif requis: Au moins les éléments suivants
.... coding 1..* Coding Code defined by a terminology system
Valeur fixe : (Complexe)
..... system 1..1 uri Identity of the terminology system
Valeur fixe : http://terminology.hl7.org/CodeSystem/processpriority
..... code 1..1 code Symbol in syntax defined by the system
Valeur fixe : normal
... insurance
.... sequence 1..1 positiveInt Insurance instance identifier
Motif requis: 1
.... focal 1..1 boolean Coverage to be used for adjudication
Motif requis: true
.... coverage
..... display 1..1 string Text alternative for the resource
Motif requis: Assurance Maladie

doco Documentation pour ce format

Bindings terminologiques (différentiel)

Chemin Statut Usage Jeu de valeurs (ValueSet) Version Source
Claim.type Base required ValueSet des type fr des claims 📦0.1.0 cet IG

Snapshot View

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Claim 0..* Claim Ceci est un élément abstrait profile. Enfant profiles: DMClaimPMSIMCO
Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Bindings AdditionnelsBut
AllLanguages Binding Max
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for claim
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type Σ 1..1 CodeableConcept Champ du PMSI concerné.
Binding: ValueSet des type fr des claims (required)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Motif requis: claim
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created Σ 1..1 dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 Reference(Organization) Target
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Entité juridique émettrice
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Motif requis: Au moins les éléments suivants
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Valeur fixe : (Complexe)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Valeur fixe : http://terminology.hl7.org/CodeSystem/processpriority
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Valeur fixe : normal
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment referral
... facility 0..1 Reference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
.... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
Motif requis: 1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
Motif requis: true
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(Coverage) Insurance information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Non ordonné, Ouvert par value:url
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 1..1 string Text alternative for the resource
Motif requis: Assurance Maladie
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total 0..1 Money Total claim cost

doco Documentation pour ce format

Bindings terminologiques

Chemin Statut Usage Jeu de valeurs (ValueSet) Version Source
Claim.language Base preferred Common Languages 📍4.0.1 Std. FHIR
Claim.status Base required Financial Resource Status Codes 📍4.0.1 Std. FHIR
Claim.type Base required ValueSet des type fr des claims 📦0.1.0 cet IG
Claim.subType Base example Example Claim SubType Codes 📍4.0.1 Std. FHIR
Claim.use Base required Use 📍4.0.1 Std. FHIR
Claim.priority Base example Process Priority Codes 📍4.0.1 Std. FHIR
Claim.fundsReserve Base example FundsReserve 📍4.0.1 Std. FHIR
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 Std. FHIR
Claim.payee.type Base example PayeeType 📍4.0.1 Std. FHIR
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 Std. FHIR
Claim.careTeam.qualification Base example Example Provider Qualification Codes 📍4.0.1 Std. FHIR
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.0.1 Std. FHIR
Claim.supportingInfo.​code Base example Exception Codes 📍4.0.1 Std. FHIR
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.0.1 Std. FHIR
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 Std. FHIR
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.0.1 Std. FHIR
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 Std. FHIR
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 Std. FHIR
Claim.procedure.type Base example Example Procedure Type Codes 📍4.0.1 Std. FHIR
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 Std. FHIR
Claim.insurance.coverage.​type Base extensible ResourceType 📍4.0.1 Std. FHIR
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
Claim.item.revenue Base example Example Revenue Center Codes 📍4.0.1 Std. FHIR
Claim.item.category Base example Benefit Category Codes 📍4.0.1 Std. FHIR
Claim.item.productOrService Base example USCLS Codes 📍4.0.1 Std. FHIR
Claim.item.modifier Base example Modifier type Codes 📍4.0.1 Std. FHIR
Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 Std. FHIR
Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 Std. FHIR
Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 Std. FHIR
Claim.item.subSite Base example Surface Codes 📍4.0.1 Std. FHIR
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 Std. FHIR
Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 Std. FHIR
Claim.item.detail.productOrService Base example USCLS Codes 📍4.0.1 Std. FHIR
Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 Std. FHIR
Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.0.1 Std. FHIR
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍4.0.1 Std. FHIR

Contraintes

Id Grade Chemin(s) Description Expression
dom-2 error Claim If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Claim If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Claim If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Claim If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 bonne pratique Claim A resource should have narrative for robust management text.`div`.exists()
ele-1 error **TOUS** les éléments All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **TOUTES** les extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from Claim

Résumé

Obligatoire : 1 élément

Structures

Cette structure fait référence à ces autres structures:

 

Other representations of profile: CSV, Excel, Schematron