Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.1 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.1 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyClaim | Version: 0.0.1 | |||
| Draft as of 2025-08-31 | Computable Name: NzPharmacyClaim | |||
A FHIR resource profile for NZ Pharmacy Claims, including extensions for patient cohort and claimant information.
This profile is used to represent pharmacy claims in New Zealand, including patient cohort information and claimant details.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  Claim |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |
  implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
  Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
   extension:patientCohort |
0..1 | CodeableConcept | Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required) | |
| extension:claimantNumber |
0..1 | string | Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number | |
 extension:originatingClaimantNumber |
0..1 | string | Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number | |
 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. |
 type |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
| use |
Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, 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) | Party responsible for the claim |
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
| supportingInfo |
1..* | BackboneElement | Supporting information | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Information instance identifier | |
 category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |
| insurance |
Σ | 1..1 | BackboneElement | Patient insurance information |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
Σ | 1..1 | positiveInt | Insurance instance identifier |
| focal |
Σ | 1..1 | boolean | Coverage to be used for adjudication |
| coverage |
Σ | 1..1 | Reference(Coverage) | Insurance information |
| item |
1..* | BackboneElement | Product or service provided | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:patientFlag |
0..1 | boolean | Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag | |
| extension:prescriberFlag |
0..1 | boolean | Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag | |
| extension:prescriptionFlag |
0..1 | boolean | Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag | |
| extension:doseFlag |
0..1 | boolean | Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag | |
| extension:groupId |
0..1 | string | Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Item instance identifier | |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
 Slices for serviced[x] |
1..1 | date | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |
| serviced[x]:servicedDate |
1..1 | date | Date or dates of service or product delivery | |
 detail |
1..* | BackboneElement | Product or service provided | |
 Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:balanceOwing |
0..1 | string | Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing | |
| extension:wastageQuantity |
0..1 | Quantity | Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity | |
| extension:cbsSubsidy |
0..1 | Money | CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy | |
| extension:cbsPackSize |
0..1 | Quantity | CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Item instance identifier | |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
| quantity |
1..1 | SimpleQuantity | Count of products or services | |
| net |
1..1 | Money | Total item cost | |
| total |
1..1 | Money | Total claim cost | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | |
| Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-typeFrom the FHIR Standard | |
| Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1From the FHIR Standard | |
| Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityFrom the FHIR Standard | |
| Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategoryFrom the FHIR Standard | |
| Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | |
| Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| Claim |
0..* | Claim | 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.
| |||||
| 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 | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:patientCohort |
0..1 | CodeableConcept | Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required) | |||||
| extension:claimantNumber |
0..1 | string | Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number | |||||
| extension:originatingClaimantNumber |
0..1 | string | Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number | |||||
| 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 | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
| 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. | ||||
| 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) | Party responsible for the claim | ||||
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
| 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 |
1..* | BackboneElement | Supporting information | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |||||
| 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..1 | BackboneElement | Patient insurance information | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
Σ | 1..1 | positiveInt | Insurance instance identifier | ||||
| focal |
Σ | 1..1 | boolean | Coverage to be used for adjudication | ||||
| identifier |
0..1 | Identifier | Pre-assigned Claim number | |||||
| coverage |
Σ | 1..1 | Reference(Coverage) | Insurance information | ||||
| businessArrangement |
0..1 | string | Additional provider contract number | |||||
| preAuthRef |
0..* | string | Prior authorization reference number | |||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| accident |
0..1 | BackboneElement | Details of the event | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| date |
1..1 | date | When the incident occurred | |||||
| type |
0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |||||
| location[x] |
0..1 | Where the event occurred | ||||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| item |
1..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:patientFlag |
0..1 | boolean | Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag | |||||
| extension:prescriberFlag |
0..1 | boolean | Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag | |||||
| extension:prescriptionFlag |
0..1 | boolean | Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag | |||||
| extension:doseFlag |
0..1 | boolean | Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag | |||||
| extension:groupId |
0..1 | string | Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id | |||||
| 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. | |||||
| Slices for serviced[x] |
1..1 | date | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |||||
| serviced[x]:servicedDate |
1..1 | date | Date or dates of service or product delivery | |||||
| location[x] |
0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
| locationCodeableConcept |
CodeableConcept | |||||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| quantity |
0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| bodySite |
0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
| subSite |
0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
| encounter |
0..* | Reference(Encounter) | Encounters related to this billed item | |||||
| detail |
1..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:balanceOwing |
0..1 | string | Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing | |||||
| extension:wastageQuantity |
0..1 | Quantity | Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity | |||||
| extension:cbsSubsidy |
0..1 | Money | CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy | |||||
| extension:cbsPackSize |
0..1 | Quantity | CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize | |||||
| 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 |
1..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
1..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| subDetail |
0..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Item instance identifier | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity |
0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| total |
1..1 | Money | Total claim cost | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| Claim.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard
| ||||
| Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | ||||
| Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-typeFrom the FHIR Standard | ||||
| Claim.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtypeFrom the FHIR Standard | ||||
| Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1From the FHIR Standard | ||||
| Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityFrom the FHIR Standard | ||||
| Claim.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserveFrom the FHIR Standard | ||||
| Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationshipFrom the FHIR Standard | ||||
| Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetypeFrom the FHIR Standard | ||||
| Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamroleFrom the FHIR Standard | ||||
| Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualificationFrom the FHIR Standard | ||||
| Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategoryFrom the FHIR Standard | ||||
| Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionFrom the FHIR Standard | ||||
| Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonFrom the FHIR Standard | ||||
| Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10From the FHIR Standard | ||||
| Claim.diagnosis.type | example | ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistypeFrom the FHIR Standard | ||||
| Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admissionFrom the FHIR Standard | ||||
| Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroupFrom the FHIR Standard | ||||
| Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-typeFrom the FHIR Standard | ||||
| Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-proceduresFrom the FHIR Standard | ||||
| Claim.accident.type | extensible | ActIncidentCodehttp://terminology.hl7.org/ValueSet/v3-ActIncidentCode | ||||
| Claim.item.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerFrom the FHIR Standard | ||||
| Claim.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryFrom the FHIR Standard | ||||
| Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| Claim.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| Claim.item.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codeFrom the FHIR Standard | ||||
| Claim.item.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-placeFrom the FHIR Standard | ||||
| Claim.item.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/toothFrom the FHIR Standard | ||||
| Claim.item.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surfaceFrom the FHIR Standard | ||||
| Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerFrom the FHIR Standard | ||||
| Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryFrom the FHIR Standard | ||||
| Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codeFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codeFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Claim
Summary
Mandatory: 8 elements
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Claim |
0..* | Claim | Claim, Pre-determination or Pre-authorization | |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:patientCohort |
0..1 | CodeableConcept | Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required) | |
| extension:claimantNumber |
0..1 | string | Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number | |
| extension:originatingClaimantNumber |
0..1 | string | Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number | |
| 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. |
| type |
Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
| use |
Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, 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) | Party responsible for the claim |
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
| supportingInfo |
1..* | BackboneElement | Supporting information | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Information instance identifier | |
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |
| insurance |
Σ | 1..1 | BackboneElement | Patient insurance information |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
Σ | 1..1 | positiveInt | Insurance instance identifier |
| focal |
Σ | 1..1 | boolean | Coverage to be used for adjudication |
| coverage |
Σ | 1..1 | Reference(Coverage) | Insurance information |
| item |
1..* | BackboneElement | Product or service provided | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:patientFlag |
0..1 | boolean | Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag | |
| extension:prescriberFlag |
0..1 | boolean | Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag | |
| extension:prescriptionFlag |
0..1 | boolean | Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag | |
| extension:doseFlag |
0..1 | boolean | Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag | |
| extension:groupId |
0..1 | string | Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Item instance identifier | |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
| Slices for serviced[x] |
1..1 | date | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |
| serviced[x]:servicedDate |
1..1 | date | Date or dates of service or product delivery | |
| detail |
1..* | BackboneElement | Product or service provided | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:balanceOwing |
0..1 | string | Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing | |
| extension:wastageQuantity |
0..1 | Quantity | Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity | |
| extension:cbsSubsidy |
0..1 | Money | CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy | |
| extension:cbsPackSize |
0..1 | Quantity | CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence |
1..1 | positiveInt | Item instance identifier | |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
| quantity |
1..1 | SimpleQuantity | Count of products or services | |
| net |
1..1 | Money | Total item cost | |
| total |
1..1 | Money | Total claim cost | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | |
| Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-typeFrom the FHIR Standard | |
| Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1From the FHIR Standard | |
| Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityFrom the FHIR Standard | |
| Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategoryFrom the FHIR Standard | |
| Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | |
| Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Differential View
This structure is derived from Claim
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| Claim |
0..* | Claim | 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.
| |||||
| 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 | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:patientCohort |
0..1 | CodeableConcept | Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required) | |||||
| extension:claimantNumber |
0..1 | string | Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number | |||||
| extension:originatingClaimantNumber |
0..1 | string | Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number | |||||
| 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 | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
| 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. | ||||
| 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) | Party responsible for the claim | ||||
| priority |
Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
| 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 |
1..* | BackboneElement | Supporting information | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | |||||
| 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..1 | BackboneElement | Patient insurance information | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
Σ | 1..1 | positiveInt | Insurance instance identifier | ||||
| focal |
Σ | 1..1 | boolean | Coverage to be used for adjudication | ||||
| identifier |
0..1 | Identifier | Pre-assigned Claim number | |||||
| coverage |
Σ | 1..1 | Reference(Coverage) | Insurance information | ||||
| businessArrangement |
0..1 | string | Additional provider contract number | |||||
| preAuthRef |
0..* | string | Prior authorization reference number | |||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| accident |
0..1 | BackboneElement | Details of the event | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| date |
1..1 | date | When the incident occurred | |||||
| type |
0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |||||
| location[x] |
0..1 | Where the event occurred | ||||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| item |
1..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:patientFlag |
0..1 | boolean | Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag | |||||
| extension:prescriberFlag |
0..1 | boolean | Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag | |||||
| extension:prescriptionFlag |
0..1 | boolean | Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag | |||||
| extension:doseFlag |
0..1 | boolean | Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag | |||||
| extension:groupId |
0..1 | string | Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id | |||||
| 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. | |||||
| Slices for serviced[x] |
1..1 | date | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | |||||
| serviced[x]:servicedDate |
1..1 | date | Date or dates of service or product delivery | |||||
| location[x] |
0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
| locationCodeableConcept |
CodeableConcept | |||||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| quantity |
0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| bodySite |
0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
| subSite |
0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
| encounter |
0..* | Reference(Encounter) | Encounters related to this billed item | |||||
| detail |
1..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:balanceOwing |
0..1 | string | Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing | |||||
| extension:wastageQuantity |
0..1 | Quantity | Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity | |||||
| extension:cbsSubsidy |
0..1 | Money | CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy | |||||
| extension:cbsPackSize |
0..1 | Quantity | CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize | |||||
| 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 |
1..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
1..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| subDetail |
0..* | BackboneElement | Product or service provided | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence |
1..1 | positiveInt | Item instance identifier | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity |
0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique device identifier | |||||
| total |
1..1 | Money | Total claim cost | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| Claim.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard
| ||||
| Claim.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | ||||
| Claim.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-typeFrom the FHIR Standard | ||||
| Claim.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtypeFrom the FHIR Standard | ||||
| Claim.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1From the FHIR Standard | ||||
| Claim.priority | example | ProcessPriorityCodeshttp://hl7.org/fhir/ValueSet/process-priorityFrom the FHIR Standard | ||||
| Claim.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserveFrom the FHIR Standard | ||||
| Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodeshttp://hl7.org/fhir/ValueSet/related-claim-relationshipFrom the FHIR Standard | ||||
| Claim.payee.type | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetypeFrom the FHIR Standard | ||||
| Claim.careTeam.role | example | ClaimCareTeamRoleCodeshttp://hl7.org/fhir/ValueSet/claim-careteamroleFrom the FHIR Standard | ||||
| Claim.careTeam.qualification | example | ExampleProviderQualificationCodeshttp://hl7.org/fhir/ValueSet/provider-qualificationFrom the FHIR Standard | ||||
| Claim.supportingInfo.category | example | ClaimInformationCategoryCodeshttp://hl7.org/fhir/ValueSet/claim-informationcategoryFrom the FHIR Standard | ||||
| Claim.supportingInfo.code | example | ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exceptionFrom the FHIR Standard | ||||
| Claim.supportingInfo.reason | example | MissingToothReasonCodeshttp://hl7.org/fhir/ValueSet/missing-tooth-reasonFrom the FHIR Standard | ||||
| Claim.diagnosis.diagnosis[x] | example | ICD-10Codeshttp://hl7.org/fhir/ValueSet/icd-10From the FHIR Standard | ||||
| Claim.diagnosis.type | example | ExampleDiagnosisTypeCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosistypeFrom the FHIR Standard | ||||
| Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosis-on-admissionFrom the FHIR Standard | ||||
| Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodeshttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroupFrom the FHIR Standard | ||||
| Claim.procedure.type | example | ExampleProcedureTypeCodeshttp://hl7.org/fhir/ValueSet/ex-procedure-typeFrom the FHIR Standard | ||||
| Claim.procedure.procedure[x] | example | ICD-10ProcedureCodeshttp://hl7.org/fhir/ValueSet/icd-10-proceduresFrom the FHIR Standard | ||||
| Claim.accident.type | extensible | ActIncidentCodehttp://terminology.hl7.org/ValueSet/v3-ActIncidentCode | ||||
| Claim.item.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerFrom the FHIR Standard | ||||
| Claim.item.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryFrom the FHIR Standard | ||||
| Claim.item.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| Claim.item.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| Claim.item.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codeFrom the FHIR Standard | ||||
| Claim.item.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-placeFrom the FHIR Standard | ||||
| Claim.item.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/toothFrom the FHIR Standard | ||||
| Claim.item.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surfaceFrom the FHIR Standard | ||||
| Claim.item.detail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerFrom the FHIR Standard | ||||
| Claim.item.detail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryFrom the FHIR Standard | ||||
| Claim.item.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| Claim.item.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| Claim.item.detail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codeFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodeshttp://hl7.org/fhir/ValueSet/ex-revenue-centerFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.category | example | BenefitCategoryCodeshttp://hl7.org/fhir/ValueSet/ex-benefitcategoryFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codeFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Claim
Summary
Mandatory: 8 elements
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Other representations of profile: CSV, Excel, Schematron
